Director, Utilization Management
Company: Centene Corporation
Location: Oklahoma City
Posted on: September 14, 2023
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Job Description:
You could be the one who changes everything for our 28 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
workplace flexibility.
Oklahoma Complete Health, a Centene company, is committed to
providing quality healthcare solutions to transform the health of
Oklahomans.
At Oklahoma Complete Health, we are community advocates and
change-makers in search of an inclusive culture grounded by our
commitment to work-life balance, competitive compensation, and
continuous career development. Join us and be a part of a
collaborative, growing network of innovative thinkers delivering
solutions at the local level.
Position Purpose: Oversees daily operations and is responsible for
outcomes for prior authorization/preservice review and/or
inpatient/concurrent review, may oversee areas of health support
functions including intake, correspondence, and telephonic
operations
Ensure handoff to, and collaboration with, case and disease
management
Provide support to Provider Relations issues related to Utilization
issues for hospitals and physician providers.
Coordinate efforts with the Member Services and Connections
Departments to address members and providers issues and concerns in
compliance with medical management requirements.
Maintain compliance with National Committee for Quality Assurance
(NCQA) standards for utilization management functions for the prior
authorization unit.
Develop, implement and maintain policies and procedures regarding
the prior authorization function.
Identify quality and risk management issues and facilitate the
collection of information for quality improvement and reporting
purposes.
Compile and review multiple reports for statistical and financial
tracking purposes to identify utilization trends and assist in
financial forecasting.
Must reside in Oklahoma
Education/Experience: Bachelor's degree in Nursing or equivalent
experience. 5+ years of nursing experience in an acute care setting
or medical/surgical, pediatrics, or obstetric in a managed care
environment. 1+ years of utilization management and/or case
management experience. Previous management experience including
responsibilities for hiring, training, assigning work and managing
performance of staff.
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development.
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.
Keywords: Centene Corporation, Oklahoma City , Director, Utilization Management, Executive , Oklahoma City, Oklahoma
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