Manager, Utilization Management

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🔥 3 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $87k - $161.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 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

• Manage Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals teams • Ensure appropriate care to members and compliance with applicable guidelines, policies, and procedures • Review and analyze utilization management activities, operations, costs, and forecasted data to identify improvement areas • Develop, implement, and maintain utilization management policies and procedures • Review utilization management reports, identify trends, and provide recommendations to senior leadership • Maintain knowledge of utilization management processes, regulations, accreditation standards, and industry best practices • Educate and provide resources to the utilization management team • Facilitate communication among utilization management team, members, and providers • Collaborate with senior management to develop and implement UM policies, procedures, and guidelines • Provide updates and insights on team goals and objectives • Coach and guide the utilization management team on quality and performance standards • Assist with onboarding, hiring, and training team members • Lead and champion change within the scope of responsibility • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• Candidates must reside in Oklahoma • Active RN license required: State Licensure and/or Compact State Licensure • Graduate of an Accredited School of Nursing or Bachelor's degree and 5+ years of related experience • 2+ years supervisory experience preferred • Knowledge of utilization management principles preferred • Experience in healthcare leadership, utilization management, and managed care • Willingness to participate in weekend on-call coverage • Computer proficiency and proficiency in Microsoft Office applications • Excellent communication and customer service skills • Strong attention to detail, organizational and management abilities, and effective time management skills

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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 and diversity commitment

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