Centene
Director, Utilization Management P2P Support Operations
5 days agoWhat's your preference?
Job Description
- Req#: 1612565
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $242,500.00 per year
- Comprehensive benefits package including health insurance, 401K, and stock purchase plans
- Tuition reimbursement and paid time off plus holidays
- Flexible work options with remote, hybrid, field, or office schedules
- Opportunity for career advancement and growth within the organization
What to Expect (Job Responsibilities):
- Direct and manage the utilization management team to ensure compliance with corporate, state, and NCQA standards
- Analyze and report on utilization trends to enhance the effectiveness of the utilization program
- Lead process improvements to achieve cost-effective healthcare results
- Oversee the Peer-to-Peer Call Center operations, ensuring timely communication with providers and clinical teams
- Develop and monitor service level agreements (SLAs) and key performance metrics for call center performance
What is Required (Qualifications):
- Bachelor's degree and 7+ years of related experience, including prior management experience
- 4+ years of management experience preferred
- Expert knowledge of industry regulations, policies, and standards preferred
- Healthcare background in a call center environment is highly preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred
How to Stand Out (Preferred Qualifications):
- Demonstrated leadership abilities within healthcare management
- Experience with utilization management strategies and operations
- Familiarity with budget management and inter-departmental collaboration
- Knowledge of performance improvement methodologies in healthcare
- Strong communication skills with a focus on provider and member experience
#HealthcareServices #UtilizationManagement #CareerOpportunity #CompetitivePay #RemoteWorkOptions
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."About the company
Centene Corporation is a publicly traded managed care company based in St.
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