This job is archived
(Archived) RN
Job Description
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.
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.
#LI-RA1
Employee Status:
RegularJob Level:
ManagerJob Type:
RegularMore Information About the Job
What's exciting about this opportunity?
***Top of the salary range and MAX is actually $103, 200 but this candidate would have to be PERFECT for that kind of salary.*** MUST HAVE CURRENT RN LICENSE (CAN BE OUT OF STATE). At the end of the day, there is nothing more important than the health of you and your loved ones. Centene lives out that passion by serving over 4.4 million members through programs and services to government sponsored healthcare programs, focusing on under-insured and uninsured individuals. Centene is striving to transform the health of the community, one person at a time. Centene's most important assets are its employees. We provide benefits for our employees as a whole person ' health and well-being, financial, work and life balance. Our continued growth allows for advancement in a quick-paced environment.
How would you describe the team and culture?
This team is made up of VP, director and 4 manager levels. This individual will oversee 15-20 case managers which are all of our nurses (telephonic). Clinical and non clinical sides make up the team, but this is on the clinical side.
What are the top 3-4 things the person in this position will be challenged with in the first 60-90 days?
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.
12 months from now, what would the person in this position have accomplished to be successful?
Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.
What are you looking for on the resume, and why?
HAVE TO HAVE: 1. Bachelor degree in NURSING (can have an associate's or bachelor's outside of nursing if and only if they have current license) ***WILL NOT ACCEPT LPNs, LVNs*** 2. Three years or more of Utilization review or utilization management experience 3. Managed care experience would be a huge PLUS 4. License/Certification: RN license is required!!!
What are you willing to be flexible on, and how?
Case Management Certification preferred.
Is this a replacement or a new position?
New Position.
Where does the position sit in the organization and who does this position report to?
This person reports to Director of Utilization Management.
Does this position have direct reports?
Yes. Will have 15-20 case managers reporting to them.
What's the bonus percentage?
10%
Are you ready to hire the right candidate immediately?
We are looking for a candidate ASAP -- we are understaffed and the HM is very responsive.
Is relocation available?
Yes, relocation is available.
Is there flexibility in hours and/or the ability to work remotely?
No remote. Have to be on site. Normal business hours are 7am-7pm. Some days may have to come in early or stay late, and may require rotating weekend coverage if needed.