Vice President, Utilization Management

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $188.9k - $359.8k / year

⏰ Full Time

🔴 Lead

👔 Vice President

👻 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

• Plan and drive execution of Medical Management utilization programs, processes, and initiatives • Ensure achievement of health benefit ratio targets and appropriate reductions in utilization-related expenses • Provide vision and strategic leadership for compliant utilization management best practices across the enterprise • Develop customized approaches for unique markets/products • Direct collaboration within cross-functional teams to evaluate, refine, and advance utilization management programs and strategy • Lead data-driven decision-making to improve utilization management team outcomes • Identify and implement innovative solutions to improve utilization management process efficiency • Establish standard operating procedures for consistency in utilization quality and service outcomes • Design data-driven processes to identify opportunities to improve outcomes and reduce costs • Lead continuous development and improvement of policies, clinical guidelines, and aligned business practices • Innovate and implement models for utilization management operational functions in response to healthcare delivery trends and emerging care models • Ensure utilization management processes comply with regulatory requirements • Define and interpret key performance metrics, develop plans, mobilize the workforce, and achieve company utilization management goals • Establish and monitor service level agreements to meet customer needs • Serve as a change agent through decision-making and coaching of leaders and staff • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in Nursing or related healthcare field or equivalent experience required • 10+ years of experience in managed care, health plan, or provider network organizations required • Current nursing license required • Experience with Managed Medicaid preferred • Master's Degree in nursing or business preferred • Equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position

🏖️ Benefits

• Competitive pay • Health insurance • 401K and 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, subject to program eligibility