Centene Management Company LLC is hiring a Director, Utilization Management Support Operations to provide strategic leadership for all non-clinical utilization management activities. You will direct the team to ensure the appropriate application of policies and processes, support best member outcomes, and oversee functions including peer-to-peer requests, authorization entry, and discharge data management.
What You'll Do
- Oversee and manage Utilization Operations, focusing on timeliness, quality, performance outcomes, provider interactions, and regulatory compliance.
- Lead the utilization management team on performance, improvement initiatives, and career growth path considerations.
- Lead utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards.
- Review, analyze, and report on utilization trends, patterns, and impacts to deliver an effective utilization program.
- Lead process improvements for the utilization management team to achieve cost-effective healthcare results and present findings to senior leadership.
- Establish policies and procedures that incorporate best practices and ensure effective utilization reviews of members.
- Develop utilization management strategies and influence decisions by providing recommendations aligned to organizational objectives.
- Be responsible for components of the department’s budget while collaborating inter-departmentally with senior leadership.
- Execute the overall strategy for onboarding, hiring, and training new utilization management team members to ensure adequate training and high-quality care.
- Lead and champion change within scope of responsibility.
- Provide strategic and operational leadership for the Peer-to-Peer (P2P) Call Center, ensuring timely, accurate scheduling and communication.
- Develop and monitor service level agreements (SLAs) and key performance metrics for call center operations and case triage performance.
- Monitor queue volumes and workforce capacity, adjusting staffing and workflows to meet operational demands.
What We're Looking For
- Bachelor's degree
- 7+ 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
Nice to Have
- 4+ years management experience
- Expert knowledge of industry regulations, policies, and standards
- Healthcare background in a call center environment
- RN - Registered Nurse - State Licensure and/or Compact State Licensure
Benefits & Compensation
- 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
- Compensation Range: $131,100.00 - $242,500.00 per year
Work Mode
This position operates on a hybrid work model.
Centene Management Company LLC 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.
