Supervisor, Behavioral Health Utilization Management

🔥 12 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $75.3k - $135.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 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

• Supervise behavioral health utilization review clinicians and day-to-day BH utilization management team activities • Monitor clinicians and ensure compliance with applicable guidelines • Monitor and track BH utilization management resources against performance, quality, and efficiency standards • Resolve complex behavioral health care member issues • Maintain knowledge of regulations, accreditation standards, and industry best practices • Identify process and quality improvement opportunities with the team and senior management • Educate and provide resources on key initiatives and facilitate communication among the team, members, and providers • Develop and implement utilization management policies, procedures, and guidelines • Evaluate team performance and provide feedback on performance, goals, and career milestones • Coach and guide the team; provide counseling and corrective action when required • Assist with onboarding, hiring, and training team members • Attend company meetings in the absence of the people leader • Act as primary contact for escalated calls and issues requiring research or special handling • Lead and manage others in a matrixed/cross-functional environment • Lead and champion change within scope of responsibility • Present information and respond to questions from peers, leaders, and internal/external customers • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Applicants must reside in North Carolina • Must hold one of the required licenses or certifications: NC LCSW, LMHC, LPC, LMFT, LMHP, RN with state licensure and/or compact state licensure, or BCBA for ABA • Graduate of an Accredited School of Nursing or Bachelor's degree • 4+ years of related experience • License to practice independently, and/or have obtained the state required licensure • Knowledge of BH utilization management principles preferred • Prior supervisory experience preferred • Understanding of medical necessity criteria for a broad range of BH services preferred • Monday through Friday, 8:00 AM to 5:00 PM, with a rotating weekend on-call schedule

🏖️ 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