Senior Manager, Strategy
TCGplayer (an eBay company)
Manager, Utilization Management
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • Oklahoma • 🇺🇸 United States
Visit company websiteSalary
💰 $85,300 - $158,100 per year
Job Level
Mid-LevelSenior
About the role
- Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members.
- Manages utilization management issues related to member care, provider interactions, and facilitates operations within utilization management.
- Reviews and analyzes utilization management activities, operations, costs, and forecasted data to identify areas for improvement within utilization management (UM) to align to goals and objectives.
- Develops, implements, and maintains compliance with utilization management policies and procedures.
- Reviews utilization management reports to identify trends and areas of improvement and provide recommendations to senior leadership.
- Maintains knowledge of processes, regulations, accreditation standards, and industry best practices related to utilization management.
- Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers.
- Works with the senior management team to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services.
- Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards.
- Assists utilization management senior leadership with onboarding, hiring, and training utilization management team members
Requirements
- Graduate of an Accredited School of Nursing or Bachelor's degree
- 5+ years of related experience
- 2+ years supervisory experience preferred
- Knowledge of utilization management principles preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization managementclinical reviewdata analysiscompliance managementpolicy developmentreportingcost analysisforecastingcoachingtraining
Soft skills
leadershipcommunicationteam managementproblem-solvinginterpersonal skillsorganizational skillsrecommendation skillseducational skillsfacilitationcollaboration
Certifications
Registered NurseState LicensureCompact State Licensure
