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Position Purpose\\: Supervise the daily operations of the utilization management (UM) department Supervise the daily operations of the UM staff Ensure appropriate usage of resources in order to facilitate the UM process Ensure compliance within applicable state program guidelines Evaluate compliance policies and procedures and analyze/recommend enhancements Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements Identify opportunities for process improvements necessary to facilitate department functions Educate staff as necessary to ensure consistent performance and adhere to standards
Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary
Education/Experience\\: 3+ years of utilization management/quality improvement experience. Working knowledge and understanding of basic utilization management and quality improvement concepts. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects. RN Preferred. For Arizona Complete Health-Behavioral Health UM Team\\: Licenses/Certifications\\: Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Marriage & Family Therapist (LMFT), Licensed Professional Counselor (LPC), Licensed Associate Marriage & Family Therapist (LAMFT), Licensed Associate Counselor (LAC), Licensed Associate Master Social Worker (LAMSW) or Registered Nurse (RN), LPN, LVNFor Sunflower Behavioral Health UM Team\\: Licenses/Certifications\\: Licensed Specialist Clinical Social Worker (LSCSW), Licensed Clinical Professional Counselor(LCPC), Licensed Clinical Marriage and Family therapist (LCMFT), or Licensed Registered Nurse (RN)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.