Director – Utilization Management
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Job Description
Directing Centene’s utilization management team and operations. Improving healthcare outcomes, compliance, cost effectiveness, and member and provider experience.
Responsibilities:
- Direct the utilization management team to ensure appropriate application of policy, procedures, and processes supporting best member outcomes
- Oversee and manage daily Utilization Management operations, including timeliness, quality, performance outcomes, provider interactions and experience, and regulatory/compliance measures
- Lead utilization management team performance, improvement, and career growth considerations
- Lead team policies and procedures to ensure compliance with corporate, state, and NCQA standards
- Review, analyze, and report on utilization trends, patterns, and impacts
- Lead process improvements to achieve cost-effective healthcare results and present to senior leadership
- Establish policies and procedures incorporating best practices for effective utilization reviews
- Develop utilization management strategies and provide recommendations aligned with organizational objectives
- Manage department budget components while collaborating inter-departmentally with senior leadership
- Execute onboarding, hiring, and training strategy for new team members
- Lead and manage others in a matrixed/cross-functional environment with tight timeframes and strict deadlines
- Lead and champion change within scope of responsibility
- Perform other duties as assigned
- Comply with all policies and standards
Requirements:
- Bachelor's degree and 7+ years of related experience, including prior management experience
- Equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position may substitute for the degree and experience requirement
- 4+ years management experience preferred
- Expert knowledge of industry regulations, policies, and standards preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
- additional forms of incentives may be included in total compensation
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