You could be the one who changes everything for our 26 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.

Position Purpose: Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.

• Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
• Promote compliance with federal and state regulations and contractual agreements.
• Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
• Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease the business unit's financial exposure.
• Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
• Facilitate on-going communication between utilization management staff and contracted providers.
• Develop staff skills and competencies through training and experience. Available to non-clinical staff as a resource for clinical questions.

Education/Experience: Bachelor’s degree in related field or equivalent experience. Bachelor’s degree in nursing preferred. 3+ years utilization management and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Thorough knowledge of utilization management and clinical nursing. Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

License/Certification: RN license. Case Management Certification preferred.

For Fidelis Care only: NYS unrestricted license as Registered Nurse (RN) License, Licensed Occupational Therapist (OT), Licensed Clinical Social Worker (LCSW) or License Physical Therapist (PT)

The salary range for NY is: $80,600 - $145,100 per year

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

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.

Job Type: Full-time

Pay: $80,600.00 - $145,100.00 per year

Benefits:

• 401(k)
• Health insurance
• Paid time off
• Tuition reimbursement

Medical specialties:

• Medical-Surgical

Schedule:

• Day shift

Education:

• Bachelor's (Preferred)

Experience:

• Utilization review: 3 years (Preferred)
• supervisor: 1 year (Preferred)

License/Certification:

• New York State RN License (Preferred)

Work Location: Remote

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