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Manager, Utilization Management in Tempe, AZ

Centene Corp

Tempe, AZ 85281
1w ago
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industry:

specialty:

Allied Health Professionals, Healthcare Management

experience:

Less than 5 years

Job Description

Description:

Position Purpose: Perform duties to conduct and manage the day to day operations of the utilization management functions to include denials. Communicate with departmental and plan administrative staff to facilitate daily operations of the utilization management functions.


Ensure compliance with established referral, pre-certification and authorization policies, procedures and processes

Facilitate ongoing communication between care management staff, utilization management staff and contracted providers.

Maintain compliance with URAC, federal and state regulations and contractual agreements, including HIPAA

Develop, implement and maintain compliance regarding medical utilization management and appeals functions

Monitor the effectiveness of existing outreach and intervention efforts

Ensure appropriate medical necessity review for all levels of care and assure appropriate knowledge, education, and interve

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Valid through: 2020-4-8

About Centene Corporation

Centene Corporation is a large publicly-traded company and a leading multi-line healthcare enterprise that serves as a major intermediary for both government-sponsored and privately-insured health care programs. The main lines of Centene include Medicare, Medicaid, The Health Insurance Marketplace System,, Tricare, as well as traditional commercial insurance. It is the second-largest publicly-traded corporation in the state of Missouri.
Total Jobs:
141
Total Experts:
27
Average Pay:
$121,392
Total value of jobs:
$30,955,000
% Masters:
44%
* Ladders Estimates