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 candidate will need to reside in NY or the Tri-State Area with 1x per week in a local office with the remainder of work being remote.
Position Purpose: Oversee utilization pre-service and/or inpatient/concurrent operations under corporate shared services structure. Informs regional, functional, and line of business UM strategy.
• Lead and direct the overall operation of the utilization management function to ensure consistency of policies, procedures and work flows
• Evaluate utilization management program effectiveness and recommend improvements, including needs analysis and planning
• Ensures provider satisfaction with utilization management program
• Ensure utilization management targets for all products are met for the annual operating plan, state requirements and financial management
• Ensure that utilization management process is integrated with case management program
• Maintain compliance with National Committee for Quality Assurance (NCQA) standards for case management function.
• Develop and implement methods, policies and procedures to improve the departments efficiency and effectiveness.
• Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting
• Review various reports and identify trends to assist in financial forecasting
Education/Experience:
Bachelor’s degree in nursing, related field, or equivalent experience. 7+ years of utilization management, clinical nursing and quality improvement experience in a managed care setting.
License/Certification: Current state’s RN license
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Pay Range: $139,500.00 – $258,300.00 per year
Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law.
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.
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