Senior Leader, Utilization Management - LTC/Medicaid

Centene Corporation; Florida; Hybrid; 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 remote/hybrid/field/office S"

Job summary

Centene Corporation in Florida is seeking an experienced Senior Director of Utilization Management to lead the LTC utilization operations, ensuring policy alignment and NCQA standards.

The role requires a Bachelor's degree and 7+ years of leadership in Medicaid managed care, LTSS/LTC, and prior authorization, with a focus on performance, regulatory compliance, and provider collaboration.

Qualifications

• Bachelor's degree with 7+ years in utilization management or related leadership roles.
• 4+ years of management experience preferred.
• Expert knowledge of industry regulations, policies, and NCQA standards preferred.

Responsibilities

• Lead utilization management team on performance, improvement, and career growth.
• Ensure compliance with corporate, state, and NCQA standards.
• Review and report utilization trends to drive effective programs.
• Lead process improvements for cost-effective healthcare results.
• Develop strategies aligning with organizational objectives.
• Oversee onboarding, hiring, and training of UM staff.
• Lead in a matrixed environment with tight deadlines.
• Ensure adherence to policies and standards.

Skills

Leadership experience

Regulatory compliance knowledge

Healthcare operations understanding

Education

Bachelor's degree

Job description

Centene Corporation in Florida is seeking an experienced Senior Director of Utilization Management to lead the LTC utilization operations, ensuring policy alignment and NCQA standards.

The role requires a Bachelor's degree and 7+ years of leadership in Medicaid managed care, LTSS/LTC, and prior authorization, with a focus on performance, regulatory compliance, and provider collaboration.