„Centene Corporation“ yra sveikatos priežiūros ir draudimo bendrovė, daugiausia dėmesio skirianti valstybės remiamam draudimui ir bendruomenių sveikatai. Jos paslaugos apima „Medicaid“, „Medicare“, „Health Insurance Marketplace“ planus ir TRICARE paramą kariuomenės bendruomenėms. „Centene“ derina vietos lygmeniu teikiamą priežiūrą su partneryste su ne pelno organizacijomis, kad patenkintų aptarnaujamų narių poreikius. Vykdydama veiklą ir remdama bendruomenes, bendrovė taip pat atsižvelgia į aplinkosaugą ir etišką valdymą.
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.
Jungtinės Valstijos
Florida121 500 $ – 224 900 $ / metai
NuotolinisVisas etatasVadovasPrivaloma Kalba: anglųDirektoriusAprašymas
- 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.
Reikalavimai
- 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.
Privalumai
- 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.