LogoFresh Jobs Ahead
Centene Corporation
Centene Corporation
ConsultingHealthcareInsurance
Centene Corporation is a healthcare and insurance company focused on government-sponsored coverage and community health. Its services include Medicaid, Medicare, Health Insurance Marketplace plans, and TRICARE support for military communities. Centene combines localized care delivery with partnerships with nonprofit organizations to address the needs of the members it serves. The company also incorporates environmental responsibility and ethical governance into its approach to operating and supporting communities.
LinkedIn
Company Jobs

Remote Director of Utilization Management, Florida — Centene

Lead Florida utilization management teams and long-term care operations at Centene. Guide compliance, service performance, and initiatives that support member outcomes.

USUnited StatesFLFlorida
$121,500 – $224,900 / year
RemoteFull-timeLeadEnglish RequiredDirector

Description

  • Lead the utilization management team in applying policies and processes consistently to support strong member outcomes.
  • Run day-to-day utilization management operations, covering timeliness, quality, results, provider relationships, and regulatory compliance.
  • Coach the team on performance, continuous improvement, and career development.
  • Keep utilization management policies and procedures aligned with corporate, state, and NCQA requirements.
  • Examine utilization data, identify trends and patterns, and communicate their effects.
  • Drive operational improvements and share outcomes with senior leaders.
  • Set the policies and procedures that guide effective utilization reviews.
  • Shape utilization management plans and recommend actions that advance organizational goals.
  • Oversee assigned department budget areas and work with senior leadership.
  • Direct hiring, onboarding, and training plans for incoming team members.
  • Manage employees and partners across matrixed, cross-functional teams.
  • Support organizational change and take on other assigned responsibilities.
  • Follow applicable policies and standards.

Requirements

  • Must live in Florida.
  • Bachelor’s degree and at least seven years of relevant experience, including management experience, or equivalent experience demonstrated through applicable knowledge, responsibilities, scope, and skills.
  • At least four years of management experience is preferred.
  • Substantial experience in long-term care utilization management.
  • Experience with Medicaid managed care, LTSS/LTC, prior authorization, and care management operations.
  • Expertise in industry regulations, policies, and standards is preferred.
  • Registered Nurse (RN) license in a state or compact state is preferred.

Benefits

  • Competitive compensation.
  • Health coverage.
  • 401(k) plan.
  • Employee stock purchase plans.
  • Tuition assistance.
  • Paid leave and holidays.
  • Remote, hybrid, field, or office work arrangements, depending on role needs.
  • Total compensation may include additional incentive programs.
  • Equal opportunity employer with a commitment to diversity.

Related Jobs

Intermedia Cloud Communications

Software Developer, .NET

Intermedia Cloud Communications
1,001 – 5,000 Employees
ConsultingHealthcareLegal
GEGeorgiaHybridFull-timeMiddleSeniorEnglish RequiredFull-stack EngineerSoftware Engineer
.NETASP.NETAzureCloudDistributed SystemsDockerJavaScriptKubernetesMicroservicesSQL

Build scalable .NET services for Intermedia Cloud Communications, including cloud email, Microsoft 365 integrations, APIs, and secure applications. Work across modernization, reliability, and cloud-native services.

Open
Walmart

Principal Software Engineer, Walmart Retail and eCommerce Platforms

Walmart
B2CeCommerceRetail
INIndiaOn-siteFull-timeLeadEnglish RequiredFull-stack EngineerSoftware Engineer
AzureCloudDistributed SystemsGoogle Cloud PlatformJavaJavaScriptKafkaMavenMicroservicesNode.jsNoSQLReactReact NativeSDLCSpringSpring Boot

Lead architecture and engineering for Walmart’s international retail and eCommerce platforms, including customer engagement and contextual advertising systems. Guide teams in building scalable microservices and delivering reliable software.

Open