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Director, Utilization Management
Centene Corporation. Direct the utilization management team to support appropriate policy and process application and best member outcomes .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management, focusing on compliance with corporate, state, and NCQA standards while driving team performance and operational improvements. Proficient in managing budgets, leading cross-functional teams, and developing strategies aligned with organizational objectives.
Highest-signal resume keywords
Utilization ManagementLong-Term Care (LTC) ManagementMedicaid Managed CareRN - Registered Nurse LicensureTeam Leadership
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ReviewPolicy DevelopmentData AnalysisPerformance ImprovementRegulatory Compliance
Soft Skills
Team ManagementChange ManagementCollaborationCommunication
Certifications & Qualifications
RN - Registered Nurse LicensureCompact State Licensure
Industry Keywords
Utilization Management OperationsPrior AuthorizationCare ManagementLTSS/LTCNCQA Standards
About the role
Key responsibilities & impact- Direct the utilization management team to support appropriate policy and process application and best member outcomes
- Oversee daily Utilization Management operations, including timeliness, quality, performance outcomes, provider interactions and experience, and regulatory/compliance measures
- Lead team performance, improvement, and career growth considerations
- Ensure utilization management policies and procedures comply with corporate, state, and NCQA standards
- Review, analyze, and report utilization trends, patterns, and impacts
- Lead process improvements and present results to senior leadership
- Establish policies and procedures for effective utilization reviews
- Develop utilization management strategies and provide recommendations aligned with organizational objectives
- Manage department budget components and collaborate with senior leadership
- Lead onboarding, hiring, and training strategies for new team members
- Lead and manage others in a matrixed/cross-functional environment
- Champion change and perform other assigned duties
- Comply with all policies and standards
Requirements
What you’ll need- Applicants must reside in Florida
- Bachelor's degree and 7+ years of related experience, including prior management experience, or equivalent experience acquired through applicable knowledge, duties, scope and skill
- 4+ years management experience preferred
- Strong background in Long-Term Care (LTC) Utilization Management
- Experience with Medicaid managed care, LTSS/LTC, prior authorization, and care management operations
- Expert knowledge of industry regulations, policies, and standards preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity