United States onlyYou 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.
Applicants must reside in the state of Florida.
A clinical license is required to be considered for this role with a high preference for one of the following: LCSW, LMHC, LPC, LMFT, or LMHP.
Position Purpose: Leads and directs the behavioral health (BH) utilization management team to ensure appropriate member care. . Ensures consistency of policies, procedures, and processes. Leads and develops BH utilization management strategies and objectives within utilization management to improve BH member care experience and process efficiencies within the department. Works with BH senior leadership on utilization management issues related to member care, provider interactions, and facilitates operations within utilization management.
- Provides oversight and leadership to the development, implementation, monitoring, and ongoing improvement of the behavioral health (BH) utilization management process
- Provides BH senior leadership team a vision and direction for the department to help achieve functional goals, and communicates goals to BH utilization management team
- Works with senior and executive leadership to ensure the BH utilization process is integrated to manage quality and risk management issues
- Leads development and updating of BH utilization management policies and procedures to ensure compliance with corporate, state, Federal, and National Committee for Quality Assurance (NCQA) standards
- Provides subject matter expertise to BH senior leadership and BH utilization management team on the latest utilization management policies, procedures, and standards
- Develops and implements BH utilization management methods, policies, and procedures to achieve cost-effective healthcare results
- Reviews reports to ensure adherence to department budget and identify trends to financially forecast
- Engages with onboarding, hiring, and training new BH utilization management team members to support future growth and strategy
- Identifies reporting needs, reviews and analyzes reports of BH utilization trends, patterns, over/under utilization, and impacts, and identifies quality and risk issues to develop improved utilization care to members related to BH
- Attends and presents at Health Plan and senior level leadership meetings
- Effectively manages Executive Level grievances or Presidential complaints that require special handling
- Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines
- Role models change management activities within their leadership team
- Exceptional presentation skills and effectively responds to questions from peers, leaders and internal/external customers
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 10+ years of related experience, including prior management experience.
5+ years management experience preferred.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Expert knowledge of BH industry regulations, policies, and standards preferred.
Advanced understanding of medical necessity criteria for a broad range of BH services preferred.
License/Certification:
- LCSW- License Clinical Social Worker required or
- LMHC-Licensed Mental Health Counselor required or
- LPC-Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
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
