Senior Director, Utilization Management Position Available In Cole, Missouri

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

• This is a remote opportunity that will have UM leadership oversight for Medicare Duals Operations team. Supporting a team in CST and MST

• Position Purpose:

• Oversee the end-to-end UM functions for Duals populations to ensure the appropriate application of policy procedures and processes to help support best member outcomes.

Oversees daily operations of Utilization Management including timeliness, quality and performance outcomes, provider interactions and experience and associated regulatory and/or compliance measures + Drive utilization strategy and operational execution, including prior authorization, concurrent review + Collaborate with Medical Directors to guide clinical decision-making processes and uphold evidence-based standards of care + Develop and nurture strong, collaborative relationships with provider networks, IPAs, delegated entities, and third-party vendors to facilitate seamless care coordination and reduce friction in the UM process. + Act as the key point of contact for health plan partners and internal leadership teams to address UM trends, challenges, and opportunities. + Represent the UM function in external meetings with regulatory bodies, contracted entities, and provider groups to build trust and alignment. + Leads utilization management policies and procedures within the utilization management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards + Provides subject matter expertise to senior leadership and utilization management team on the latest utilization management policies, procedures, and standards + Develops and implements utilization management methods, policies, and procedures to achieve cost-effective healthcare results in compliance with corporate, state and National Committee for Quality Assurance (NCQA) standards + Reviews reports to ensure adherence to department budget and identify trends for impacting forecast + Engages with onboarding, hiring, and training new utilization management team members to support future growth and strategy + Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines + Leads and champions change within scope of responsibility + Performs other duties as assigned + Complies with all policies and standards

• Education/Experience:

• + Requires a Bachelor’s degree and 10+ years of related experience, including prior management experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. + 5+ years management experience preferred. + Expert knowledge of industry regulations, policies, and standards preferred.

• License/Certification:

• + RN
• Registered Nurse
• State Licensure and/or Compact State Licensure preferred

Pay Range:

$157,600.00

• $290,800.

00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act