Remote Director, Utilization Management (LTC) – FL

Centene Corp.; Northern (KY); Hybride; USD 122 000 - 225 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Résumé du poste

Centene Corp. seeks a Director of Utilization Management remote in Florida to lead the UM team, ensuring policy alignment, timely reviews, and compliant practices. The role demands expert LTC UM knowledge, Medicaid managed care experience, and strong leadership in a matrix environment.

The ideal candidate will drive process improvements, develop on-boarding and training, and partner with senior leaders to optimize member outcomes while managing budgets and regulatory requirements.

Qualifications

• Bachelor's degree in a related field with 7+ years in UM.
• Minimum 4+ years of management experience.
• RN licensure preferred.

Responsabilités

• Directs the utilization management team to ensure policy compliance and outcomes.
• Oversees operations, timeliness, quality, and provider interactions.
• Reviews utilization trends and reports to leadership.
• Leads budgeting, onboarding, hiring, and training for the UM team.
• Ensures NCQA standards compliance.

Connaissances

Leadership

Utilization Management

Regulatory Compliance

Budget Management

Formation

Bachelor's degree

Description du poste

Centene Corp. seeks a Director of Utilization Management remote in Florida to lead the UM team, ensuring policy alignment, timely reviews, and compliant practices. The role demands expert LTC UM knowledge, Medicaid managed care experience, and strong leadership in a matrix environment.

The ideal candidate will drive process improvements, develop on-boarding and training, and partner with senior leaders to optimize member outcomes while managing budgets and regulatory requirements.