Supervisor, Utilization Management Job at Federal Services
You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Supervise the daily operations of the utilization management (UM) department. Supervise the daily operations of the UM staffEnsure appropriate usage of resources in order to facilitate the UM process
Ensure compliance within applicable state program guidelines
Evaluate compliance policies and procedures and analyze/recommend enhancements
Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements
Identify opportunities for process improvements necessary to facilitate department functions
Educate staff as necessary to ensure consistent performance and adhere to standards
Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary
For MCOs, supervise the Transition of Care staff and provide face to face contact with inpatient members at assigned hospitals
Education/Experience: 3+ years of utilization management/quality improvement experience. Working knowledge and understanding of basic utilization management and quality improvement concepts. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
For Health Net Federal Services:
Valid Registered Nurse, licensed to practice independently in the State that they reside. Must have and maintain current, valid and unrestricted clinical license.
For Health Net Federal Services (Medical Management): Medical Management requires UM Supervisors to obtain the following specialty certification within 18 months of hire: Certified Managed Care Nurse (CMCN).
Government Security/Clearance/Citizenship: As a government contractor, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
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