Centene Corporation · 4 hours ago

Supervisor, Behavioral Health Utilization Management

Florida, United States

Full-time

Remote

Mid, Senior Level

$72K/yr - $130K/yr

4+ years exp

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Responsibilities

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 BH utilization management team to resolve complex BH care member issues related to BH

Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management

Works with BH utilization management team and senior management to identify opportunities for process and quality improvements within utilization management

Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between BH utilization management team, members, and providers

Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services

Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones

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

Attends company meetings in absence of people leader

Acts as primary contact for escalated calls/issues that require research or special handling

Leads 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

Complies with all policies and standards

Qualification

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Behavioral Health Utilization ManagementSupervisory ExperienceClinical LicensureLCSWLMHCLPCLMFTLMHPRN LicensureMedical Necessity CriteriaBCBACoachingPerformance Management