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Manager, Utilization Management
Ref No.: 17-14962
Location: Sunrise, Florida
Position Purpose: Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.
· Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
· Promote compliance with federal and state regulations and contractual agreements.
· Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
· Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease the business unit's financial exposure.
· Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
· Facilitate on-going communication between utilization management staff and contracted providers.
· Develop staff skills and competencies through training and experience. Available to non-clinical staff as a resource for clinical questions.
Qualifications:
Education/Experience: Bachelor's degree in related field or equivalent experience. Bachelor's degree in nursing preferred. 3+ years utilization management and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Thorough knowledge of utilization management and clinical nursing. Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

License/Certification: RN license. Case Management Certification preferred.


This Manager will oversee the Prior Authorization team of our UM department.

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.
Employee Status:
Regular
Travel:
Yes, 25 % of the Time
Job Level:
Manager
Job Type:
Regular
More Information About the Job
Is Relocation Available?
No

Is there a bonus structure?
10%

Are you open to sponsorship?
No

This position is:
Backfill

Is there a possibility to work remote?
No

Is there equity?
No

Are there flexible work hours?
No

Does this position have direct reports?
Yes

Who does this position report to?
Director, Utilization Management - this Manager will have 2 Supervisors reporting directly to them. Each of those Supervisors will have 15+ nurses reporting to them.

What are the 3-4 non-negotiable requirements on this position?
Bachelor's Degree in Nursing or related field. 3+ years of Utilization Management experience. In a leadership role now - Supervisor, Manager, Director, etc. Has a total of 3-5 years of experience in a leadership role. Acute care experience in their background - nursing on a NICU, PEDS, OB, ICU, Tele, Med/Surg, etc floor. Previous managed care experience (in an organization similar to Centene/Sunshine Health) - 2 years minimum. If this is not reflective on their resume & the recruiter summary they will be rejected. PLEASE present your candidates well. Florida RN License. Lives within normal driving distance to Sunrise - we are not interested in candidates that require relocation. Advanced computer user. Ability to travel 25% of the month to Maitland. They will have direct reports in both Maitland and Sunrise. Telecommute or work-from-home is NOT an option so make sure they are comfortable with driving to Sunrise FL for work daily.

What are the nice-to-have skills?
Previous leadership experience in a managed care setting.

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