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Manager, Behavioral Health Utilization Management

This job is available in 2 locations

Manager, Behavioral Health Utilization Management

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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.

Position Purpose: Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. Manages BH utilization management issues related to member care, provider interactions, and facilitates operations within utilization management.
  • Manages behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines
  • Reviews and analyzes BH utilization management activities, over/under utilization, operations, costs, and forecasted data to identify areas for improvement within utilization management (UM) to align to goals and objectives
  • Develops, implements, and maintains compliance with BH utilization management policies and procedures
  • Reviews BH utilization management and financial reports to identify trends and areas of improvement and provide recommendations to senior leadership
  • Monitors processes, regulations, contractual and accreditation standards, and industry best practices related to BH utilization management
  • Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
  • Works with the BH utilization management senior management team to develop and implement BH UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
  • Provides feedback to BH utilization management team to improve care for members and optimize utilization management processes
  • Assists BH utilization management onboarding, hiring, and training 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 manages 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 5+ years of related experience.

2+ years supervisory experience preferred.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Knowledge of BH utilization management principles preferred.
Advanced understanding of medical necessity criteria for a broad range of BH services preferred.

  • 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: $83,600.00 - $155,000.00 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. Total compensation may also include additional forms of incentives.

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.

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