Director, Utilization Management - Strategy & Impact

Centene Corporation; Town of Florida (NY); Hybrid; USD 134,000 - 247,000; Full time

Job summary

Centene Corporation in the United States is seeking a senior leader to direct the utilization management team, ensuring policy procedures are applied to support optimal member outcomes and compliant operations.

You will oversee daily UM operations, drive performance improvements, manage budgeting, onboarding, hiring, and training, and collaborate with senior leadership to align strategies. The role requires a Bachelor's degree and 7+ years of related experience, with RN licensure preferred.

Qualifications

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

Responsibilities

• Directs the utilization management team to ensure policy procedures are applied for best member outcomes.
• Oversees daily Utilization Management operations including timeliness, quality and performance.
• Leads performance improvement, budgeting, onboarding, hiring and training of UM staff.
• Ensures compliance with corporate, state, and NCQA standards.
• Reviews utilization trends and presents reports to senior leadership.

Skills

Leadership

Management experience

Policy compliance

Budgeting

Strategic planning

Communication

Education

Bachelor's degree

Job description

Centene Corporation in the United States is seeking a senior leader to direct the utilization management team, ensuring policy procedures are applied to support optimal member outcomes and compliant operations.

You will oversee daily UM operations, drive performance improvements, manage budgeting, onboarding, hiring, and training, and collaborate with senior leadership to align strategies. The role requires a Bachelor's degree and 7+ years of related experience, with RN licensure preferred.