Supervisor, Behavioral Health Utilization Management

🔥 1 minute ago

🤠 Texas – Remote

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

🎯 Requirements

• Graduate of an Accredited School of Nursing or Bachelor's degree and 4+ years of related experience • License to practice independently and/or state-required licensure • Texas, active clinical license • One of: LCSW, LMHC, LPC, LMFT, LMHP, RN state/compact state licensure, or BCBA license/certification as applicable • Knowledge of BH utilization management principles preferred • Prior supervisory experience preferred • Understanding of medical necessity criteria for a broad range of BH services preferred • Knowledge of various levels of care and Texas Administrative Code preferred • Knowledge of Local Mental Health Authorities (LMHAs) guidelines preferred • Experience conducting retrospective audits preferred • Familiarity with Medicaid, community mental health, foster care, Texas Department of Family and Protective Services, or Child Protective Services 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