Supervisor, Behavioral Health Utilization Management

About the role

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.

Responsibilities

• Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management
• Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones
• Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
• Attends company meetings in absence of people leader
• Provides coaching and guidance to the BH utilization management team for optimal performance management and provides counseling and corrective action when required
• Assists with onboarding, hiring, and training BH utilization management team members
• Works with the BH senior management to identify opportunities for process and quality improvements within utilization management
• Works with the BH utilization management team and senior management to resolve complex BH care member issues related to BH
• Works with the BH utilization management team to educate and provide resources for key initiatives and facilitate on-going communication between BH utilization management team, members, and providers
• Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines
• Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency standards
• Works with the BH utilization management team to lead and manage others in a matrixed/cross functional environment
• Leads and champions change within scope of responsibility
• Presents information and responds to questions from peers, leaders and internal/external customers
• Performs other duties as assigned

Requirements

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 4+ years of related experience
• Licenses 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
• Prior supervisory experience preferred
• Understanding of medical necessity criteria for a broad range of BH services preferred

Qualifications

• LCSW - License Clinical Social Worker required or
• LMHC - Licensed Mental Health Counselor required or
• LPC - Licensed Professional Counselor required or
• LMFT - Licensed Marital and Family Therapist (LMFT) required or
• LMHP - Licensed Mental Health Professional (LMHP) required or
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Skills

• Compliance with all policies and standards

Benefits

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.

Pay

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.

Schedule

Centene offers a flexible approach to work with remote, hybrid, field or office work schedules.