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.
** Applicants for this remote role must reside in the state of Florida and possess a valid Florida clinical license.**
Position Purpose: Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team.
- Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines
- Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency standards
- Works with BH utilization management team to resolve complex BH care member issues related to BH
- Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management
- Works with BH utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
- Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between BH utilization management team, members, and providers
- Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
- Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones
- Provides coaching and guidance to the BH utilization management team for optimal performance management and provides counseling and corrective action when required
- Assists with onboarding, hiring, and training BH utilization management team members
- Attends company meetings in absence of people leader
- Acts as primary contact for escalated calls/issues that require research or special handling
- Leads and manage others in a matrixed/cross functional environment
- Leads and champions change within scope of responsibility
- Presents information and 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 4+ years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Knowledge of BH utilization management principles preferred.
Prior supervisory experience preferred preferred.
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 or
- Board Certified Behavior Analyst (BCBA) preferred
Pay Range: $72,400.00 - $130,100.00 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. Total compensation may also include additional forms of incentives.
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