Director – Utilization Management

🔥 1 minute ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $133.7k - $247.4k / 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 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