Director, Utilization Management

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

Position Purpose

Directs the utilization management team to ensure the appropriate application of policy procedures and processes to help support best member outcomes. Oversees and manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider interactions and experience and associated regulatory and/or compliance measures. Applicants must reside in Florida.

The ideal candidate will have leadership experience and a strong background in Long-Term Care (LTC) Utilization Management, including Medicaid managed care, LTSS/LTC, prior authorization, and care management operations. Leads utilization management team on performance, improvement, and career growth path considerations. Leads utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards. Reviews, analyzes, and reports on utilization trends, patterns, and impacts to deliver an effective utilization program. Leads process improvements for the utilization management team to achieve cost-effective healthcare results and presents to senior leadership team. Establishes policies and procedures that incorporate best practices and ensure effective utilization reviews of members. Develops utilization management strategies and influences decisions by providing recommendations that align to organizational objectives. Responsible for components of the department’s budget while collaborating inter‑departmentally with senior leadership. Executes the overall strategy for onboarding, hiring, and training new utilization management team members to ensure adequate training and high quality-care to improve member and provider experience and ensure compliance. Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines. Leads and champions change within scope of responsibility. Performs other duties as assigned. Complies with all policies and standards.

Education/Experience

Requires a Bachelor's degree and 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. 4+ years management experience preferred. Expert knowledge of industry regulations, policies, and standards preferred.

License/Certification

RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred

Pay Range

$121,500.00 - $224,900.00 per year

About Us

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.

Equal Opportunity Statement

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.

Should you need an accommodation, please email [e-mail].

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.