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.

Position Purpose: Supervise and facilitate the daily operations of the case management and utilization management functions

• Oversee the workflow and day-to-day operations of high risk case management and utilization management functions, including implementation of policies and procedures

• Ensure compliance with established initial and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes

• Act as a liaison with other business units and facilitate on-going communications between case management and utilization management staff, community agencies and contracted providers

• Provide oversight of telephonic review of inpatient admissions with doctors, hospitals, and other providers

• Monitor the effectiveness for existing outreach efforts and ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk

• Analyze data to address trends or potential quality improvement opportunities including provider issues, service gaps and member needs

Education/Experience: RN license or Master’s degree in Behavioral Health or related field. 3+ years of case and/or utilization management experience. Experience in a psychiatric health care setting, including familiarity with mental health community resources. Working knowledge of a specialized or technical field, such as clinical nursing, case and/or utilization management. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

License/Certification: Current state’s unrestricted license as a LCSW, LMFT, LMHC, LPC, PhD, PsyD or RN.

For Michigan plan only: Current state’s unrestricted license as a LCSW, LMFT, LMHC, LPC, PsyD, LPN or RN.Pay Range: $67,400.00 - $121,300.00 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. Total compensation may also include additional forms of incentives.

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.