Centene Corp

Senior Manager, Behavioral Health Utilization Management

Centene Corp • $102K — $190K *
US-AnywhereRemote in Florida, US
Healthcare
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Active clinical license (LCSW, LMHC, LPC, LMFT, LMHP, or RN) required.
  • Graduate degree or Bachelor's degree in nursing or related field along with 6+ years of related experience, including management.
  • 3+ years of management experience preferred.
  • Strong knowledge of utilization management principles preferred.
  • Advanced understanding of medical necessity criteria for a broad range of BH services preferred.

Responsibilities

  • Oversee BH utilization review clinicians and ensure compliance with guidelines.
  • Review and analyze BH UM activities, identifying improvement opportunities.
  • Manage progress against UM goals and objectives for cost-effective healthcare results.
  • Review financial reports to identify trends and provide recommendations to leadership.
  • Ensure compliance with regulations, standards, and best practices in BH utilization management.
  • Identify process improvements for the BH UM team and present to senior leadership.
  • Develop and implement UM policies and procedures in collaboration with senior leadership.

Benefits

  • Comprehensive health insurance.
  • 401K and stock purchase plans.
  • Tuition reimbursement support.
  • Paid time off plus holidays.
  • Flexible work schedule options (remote, hybrid, field, or office).
Full Job Description

Position Purpose: Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. Oversees and works with senior leadership on utilization management issues related to member care, provider interactions, and facilitates operations within utilization management.

This is a remote opportunity supporting BH UM. Applicants must one of the following active clinical licenses: LCSW, LMHC, LPC, LMFT, LMHP, or RN.

  • Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines
  • Reviews and analyzes BH utilization management (UM) activities, over/under utilization, operations, costs, and forecasted data to identify areas for improvement within UM to align to goals and objectives
  • Manages and tracks achievement against goals and objectives and HBR performance for BH utilization management team to achieve cost-effective healthcare results and to ensure appropriate care to members
  • Manages and reviews BH utilization management and financial reports to identify trends and areas of improvement and provide recommendations to BH senior leadership
  • Oversees processes, regulations, contractual and accreditation standards, and industry best practices related to BH utilization management to ensure compliance with BH utilization management policies and procedures
  • Identifies process improvements for the BH utilization management team to achieve cost- effective healthcare results and presents to BH senior leadership team
  • Works with the BH senior leadership team to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
  • Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
  • Oversees the People Leader in the training of BH utilization management team members to ensure adequate training and high-quality care to BH members
  • Supports in developing the overall strategy for onboarding, hiring, and training new BH utilization management team members
  • Provides support and career development feedback to Supervisors
  • Leads talent management activities to develop and cultivate future leaders.
  • Attends company meetings in absence of people leader
  • Effectively manages escalated calls/issues that require additional research or special handling
  • Leads and manage others in a matrixed/cross functional environment with tight timeframes and strict deadlines
  • Leads and champions change within scope of responsibility
  • Effectively presents information and responds to questions from peers, leaders and internal/external customers
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience:

  • Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 6+ years of related experience, including prior management experience.
  • 3+ years management experience preferred.
  • License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
  • Strong knowledge of utilization management principles preferred.
  • Advanced understanding of medical necessity criteria for a broad range of BH services preferred.


License/Certification:

  • LCSW- License Clinical Social Worker required or
  • LMHC-Licensed Mental Health Counselor required or
  • LPC-Licensed Professional Counselor required or
  • Licensed Marital and Family Therapist (LMFT) required or
  • Licensed Mental Health Professional (LMHP) required or
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $102,900.00 - $190,500.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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