Director of Utilization Management – LTC & Medicaid Outcomes

Centene Management Company LLC; Florida; Hybride; USD 122 000 - 225 000; Plein temps

Avantages offerts par ce poste

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote/hybrid

Résumé du poste

Centene Management Company LLC is seeking an experienced leader to direct the Utilization Management team in Florida. The role focuses on applying policy procedures to support member outcomes, regulatory compliance, and continuous performance improvement.

The ideal candidate has LTC UM expertise, Medicaid managed care experience, and strong capabilities in onboarding and staff development. The position emphasizes collaboration with senior leadership and budget oversight.

Qualifications

• Bachelor's degree and 7+ years of related experience, including prior management.
• 4+ years of management experience preferred.
• Expert knowledge of industry regulations, policies, and standards preferred.

Responsabilités

• Directs the utilization management team to ensure policies and processes support member outcomes.
• Leads UM team on performance, improvement, and staff development; ensures compliance with NCQA standards.
• Oversees onboarding, hiring, and training of UM staff to ensure high quality care.
• Reviews utilization trends, reports, and cost impacts; drives process improvements and communicates to senior leadership.
• Manages departmental budget and collaborates with cross-functional leadership.

Connaissances

Leadership

Utilization management

Long-Term Care

Medicaid

Prior authorization

Operations management

Formation

Bachelor's degree

Description du poste

Centene Management Company LLC is seeking an experienced leader to direct the Utilization Management team in Florida. The role focuses on applying policy procedures to support member outcomes, regulatory compliance, and continuous performance improvement.

The ideal candidate has LTC UM expertise, Medicaid managed care experience, and strong capabilities in onboarding and staff development. The position emphasizes collaboration with senior leadership and budget oversight.