- Strategically plan for market-specific infrastructure needs, innovative interventions and resource allocation
- Develop clinical initiatives and monitor ICM, UR and disease management programs to ensure appropriate metrics are in place to deliver positive outcomes.
- Develop and maintain departmental policies and procedures
- Develop program descriptions and evaluate programs to meet set guidelines
- Ensure clinical initiatives are consistent with NCQA and state mandates
- Interface across various business unit and corporate departments to ensure effective processes and communication strategies are utilized
Oversee clinical functions in all service areas including: intensive case management (ICM), utilization review (UR), provider training and care coordination. Responsible for clinical initiatives and oversight to ensure processes are consistent with NCQA guidelines as well as state mandates. Ensure the clinical vision and philosophy is conveyed to all staff and supporting integration efforts through interface with Health Plan leadership teams.
Master’s degree in Behavioral Health or Registered Nurse required. 5+ years of related experience in utilization management or case management.
Licenses/Certifications: Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN licensed in applicable state(s).
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.