Supervisor, Behavioral Health Utilization Management

Centene Management Company LLC; Town of Texas (WI); Hybrid; USD 75,000 - 135,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/field or office

Job summary

Centene Management Company LLC is seeking a remote Supervisor, Behavioral Health Utilization Management to lead the BH utilization review clinicians and oversee day-to-day activities of the UM team, ensuring appropriate care for members.

The role requires an active Texas clinical license and a Bachelor's or nursing degree with 4+ years of related experience; leadership experience and knowledge of BH levels of care, LMHAs guidelines, and Medicaid familiarity are preferred.

Qualifications

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 4+ years of related experience.
• Active Texas clinical license is required.
• Knowledge of BH utilization management principles preferred.

Responsibilities

• Monitors BH utilization review clinicians and ensures compliance with guidelines.
• Tracks UM BH resources to meet performance and quality standards.
• Leads and mentors BH utilization management team for optimal performance.
• Develops and implements UM policies and guidelines.
• Onboards, hires, and trains team members.

Skills

Leadership

Regulatory knowledge

Audit familiarity

Team supervision

Education

Bachelor's degree

Nursing degree or equivalent

Texas professional license knowledge

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: Centene is hiring a remote Supervisor, Behavioral Health Utilization Management, to support the Specialty Behavioral Health Program team. The candidate will hold a Texas, active clinical license.

Preferred qualifications include, prior leadership experience, knowledge of various levels of care and Texas Administrative Code, Local Mental Health Authorities (LMHAs) guidelines, conducting retrospective audits, and familiarity with Medicaid, community mental health, foster care or familiar with the Texas Department of Family and Protective Services or Child Protective Services.

• 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/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/Certification

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 - one of the above listed licenses, or Board Certified Behavior Analyst (BCBA) required required.

Pay Range

$75,300.00 - $135,400.00 per year

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.