Supervisor, Behavioral Health Utilization Management

Centene Corp.; Tallahassee (FL); Remote; USD 75,000 - 135,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Corp. is seeking a remote Supervisor, Behavioral Health Utilization Management, to lead our PIC ABA team of certified BCBAs.

You will guide a team of behavior analysts, represent the team on health plan calls, and collaborate with providers and health plan partners to support sound clinical decision-making and high-quality ABA services. If you have prior supervisory experience and want to shape how ABA care is reviewed and delivered, we would love to hear from you.

Qualifications

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 4+ years of related experience.
• License to practice independently, and/or licensure as outlined by state requirements.
• Knowledge of BH utilization management principles preferred.
• Prior supervisory experience preferred.
• Understanding of medical necessity criteria for BH services preferred.

Responsibilities

• Monitors BH utilization review clinicians and ensures compliance with guidelines.
• Monitors UM BH resources to meet performance, quality, and efficiency standards.
• Leads BH UM team to resolve complex member issues related to BH care.
• Educates and provides resources for BH UM team on key initiatives and to facilitate communication with members and providers.
• Develops and implements UM policies and procedures to ensure appropriate utilization of services.

Skills

Leadership

Supervisory experience

Communication

BH utilization management knowledge

Regulatory knowledge

Education

Bachelor's degree

Nursing degree

Job description

Position Purpose

Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team.

Key Details

Are you a BCBA ready to step into clinical leadership while staying close to the field you know? Centene is seeking a remote Supervisor, Behavioral Health Utilization Management, to lead our PIC ABA team of certified BCBAs. This is a provider-facing role. You will guide a team of fellow behavior analysts, represent the team on health plan calls, and collaborate with providers and health plan partners to support sound clinical decision-making and appropriate, high-quality applied behavior analysis services. If you have prior experience leading clinicians and want to shape how ABA care is reviewed and delivered, we would love to hear from you.

Responsibilities

• Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines
• Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency standards
• Works with BH utilization management team to resolve complex BH care member issues related to BH
• Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management
• Works with BH utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
• Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between BH utilization management team, members, and providers
• Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
• Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones
• Provides coaching and guidance to the BH utilization management team for optimal performance management and provides counseling and corrective action when required
• Assists with onboarding, hiring, and training BH utilization management team members
• Attends company meetings in absence of people leader
• Acts as primary contact for escalated calls/issues that require research or special handling
• Leads and manage others in a matrixed/cross functional environment
• Leads and champions change within scope of responsibility
• Presents information and responds to questions from peers, leaders and internal/external customers
• Performs other duties as assigned.
• Complies with all policies and standards.

Education and Experience

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 4+ years of related experience.
• License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
• Knowledge of BH utilization management principles preferred.
• Prior supervisory experience preferred preferred.
• Understanding of medical necessity criteria for a broad range of BH services preferred.

License or Certification Requirements

• LCSW- License Clinical Social Worker required or
• LMHC-Licensed Mental Health Counselor required or
• LPC-Licensed Professional Counselor required or
• Licensed Marital and Family Therapist (LMFT) required or
• Licensed Mental Health Professional (LMHP) required or
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• Board Certified Behavior Analyst (BCBA) For ABA - must have a Board Certified Behavior Analyst (BCBA) required

Pay Range

Pay Range: $75,300.00 - $135,400.00 per year

About Centene

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, and 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.

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