Director, Utilization Management

🔥 15 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $121.5k - $224.9k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Direct the utilization management team to support appropriate policy and process application and best member outcomes • Oversee daily Utilization Management operations, including timeliness, quality, performance outcomes, provider interactions and experience, and regulatory/compliance measures • Lead team performance, improvement, and career growth considerations • Ensure utilization management policies and procedures comply with corporate, state, and NCQA standards • Review, analyze, and report utilization trends, patterns, and impacts • Lead process improvements and present results to senior leadership • Establish policies and procedures for effective utilization reviews • Develop utilization management strategies and provide recommendations aligned with organizational objectives • Manage department budget components and collaborate with senior leadership • Lead onboarding, hiring, and training strategies for new team members • Lead and manage others in a matrixed/cross-functional environment • Champion change and perform other assigned duties • Comply with all policies and standards

🎯 Requirements

• Applicants must reside in Florida • Bachelor's degree and 7+ years of related experience, including prior management experience, or equivalent experience acquired through applicable knowledge, duties, scope and skill • 4+ years management experience preferred • Strong background in Long-Term Care (LTC) Utilization Management • Experience with Medicaid managed care, LTSS/LTC, prior authorization, and care management operations • 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 • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity