Director, Utilization Management

Centene; Florida; Remote; USD 122,000 - 225,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,hybrid

Job summary

Centene is seeking a Director of Utilization Management in a remote-capable role based in Florida. You will lead the utilization management team to ensure policies are applied for optimal member outcomes, with emphasis on Long-Term Care UM and NCQA standards.

The role requires 7+ years of experience with prior management, a Bachelor's degree, and RN licensure is preferred. Competitive pay and flexible work options are offered.

Qualifications

• Bachelor's degree required.
• 7+ years of related experience required, including prior management experience.
• 4+ years of management experience preferred.
• RN licensure (preferred).

Responsibilities

• Lead the utilization management team on performance, improvement, and career growth.
• Ensure compliance with corporate, state, and NCQA standards.
• Review, analyze, and report on utilization trends and patterns.
• Lead process improvements for cost-effective healthcare results.
• Establish policies and procedures for effective utilization reviews.
• Develop utilization management strategies aligned with organizational objectives.
• Manage department budget components while collaborating with senior leadership.
• Oversee onboarding, hiring, and training of new team members.
• Manage others in a matrixed environment with tight deadlines.
• Champion change within the scope of responsibility.

Skills

Leadership

Utilization management

Team management

Education

Bachelor's degree

RN licensure (preferred)

Job description

About This Role

The Director of Utilization Management directs the utilization management team to ensure the appropriate application of policies and processes for optimal member outcomes. This role is ideal for candidates with leadership experience and a strong background in Long-Term Care Utilization Management.

Highlights

• Pay: $121,500 - $224,900/year
• Location: Remote, FL
• Brand/Division: Centene
• Schedule: Full Time

What You\'ll Do

• Lead the utilization management team on performance, improvement, and career growth.
• Ensure compliance with corporate, state, and NCQA standards.
• Review, analyze, and report on utilization trends and patterns.
• Lead process improvements for cost-effective healthcare results.
• Establish policies and procedures for effective utilization reviews.
• Develop utilization management strategies aligned with organizational objectives.
• Manage department budget components while collaborating with senior leadership.
• Oversee onboarding, hiring, and training of new team members.
• Manage others in a matrixed environment with tight deadlines.
• Champion change within the scope of responsibility.

Requirements

• Education: Bachelor's degree required
• Experience: 7+ years of related experience required, including prior management experience
• 4+ years of management experience preferred
• Licenses & Certifications: RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day through meaningful challenges that support individuals, families, and communities.