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.

This is a remote role- Ideal candidate will have a deep understanding of CMS & NCQA as well as expertise in Microsoft Excel.

Position Purpose: Strategic and detail-oriented leader to oversee the end-to-end lifecycle of internal and external communications across the Utilization Management. Responsible for managing correspondence workflows, developing scalable processes, vendor engagement specific to letters/correspondence and implementing automated tools to improve efficiency and overall correspondence process.

• Develop, document and maintain standardization correspondence workflows, including routing, version control and audit trails.
• Define and monitor KPIs and SLAs related to correspondence delivery, processing time, accuracy and customer impact.
• Coordinate correspondence review boards , change control committees and recurring reviews with business leaders to ensure correspondence is up to date.

• Leads utilization management team on performance, improvement, and career growth path considerations
• Leads utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
• Reviews, analyzes, and reports on utilization trends, patterns, and impacts to deliver an effective utilization program
• Leads process improvements for the utilization management team to achieve cost-effective healthcare results and presents to senior leadership team
• Establishes policies and procedures that incorporate best practices and ensure effective utilization reviews of members
• Develops utilization management strategies and influences decisions by providing recommendations that align to organizational objectives
• Responsible for components of the department's budget while collaborating inter-departmentally with senior leadership
• Executes the overall strategy for onboarding, hiring, and training new utilization management team members to ensure adequate training and high quality-care to improve member and provider experience and ensure compliance
• Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines
• Leads and champions change within scope of responsibility
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

• Requires a Bachelor's degree and 7+ years of related experience, including prior management experience.Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
• 4+ years management experience preferred.
• Expert knowledge of industry regulations, policies, and standards preferred.

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred

Pay Range: $131,100.00 - $242,500.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act