Senior Manager, Behavioral Health Utilization Management

🔥 9 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $102.9k - $190.5k / year

⏰ Full Time

🟠 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 behavioral health utilization review clinicians to ensure appropriate member care • Oversee compliance with applicable guidelines, regulations, contractual and accreditation standards, and industry best practices • Review and analyze utilization management activities, utilization levels, operations, costs, and forecasted data • Track goals, objectives, and HBR performance for the behavioral health utilization management team • Manage and review utilization management and financial reports, identify trends, and recommend improvements to senior leadership • Identify and present process improvements to the behavioral health senior leadership team • Develop and implement utilization management policies, procedures, and guidelines • Educate and provide resources to the utilization management team • Oversee training and support onboarding, hiring, and training strategies for team members • Provide career development feedback to Supervisors and lead talent management activities • Attend company meetings in the people leader's absence • Manage escalated calls and issues requiring additional research or special handling • Lead change and manage cross-functional work within tight deadlines • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Active clinical license: LCSW, LMHC, LPC, LMFT, LMHP, or RN • Graduate of an Accredited School of Nursing or Bachelor's degree • 6+ years of related experience, including prior management experience • 3+ years management experience preferred • License to practice independently and/or state-required licensure • Strong knowledge of utilization management principles preferred • Advanced understanding of medical necessity criteria for a broad range of BH services preferred • Ability to lead and manage others in a matrixed/cross-functional environment with tight timeframes and strict deadlines • Ability to present information and respond to questions from peers, leaders, and internal/external customers

🏖️ 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