Supervisor, Behavioral Health Utilization Management

Centene Corporation•Remote-FL, FL

5d•$75,300 - $135,400•Remote

About The Position

Centene is seeking a remote Supervisor, Behavioral Health Utilization Management, to lead its PIC ABA team of certified BCBAs. This provider-facing clinical leadership role guides behavior analysts, represents the team on health plan calls, and collaborates with providers and health plan partners to support sound clinical decision-making and appropriate, high-quality applied behavior analysis services. The supervisor oversees behavioral health utilization review clinicians and the day-to-day activities of the behavioral health utilization management team. The role monitors compliance with applicable guidelines and performance, quality, and efficiency standards; supports resolution of complex member issues; and works with senior management on policies, procedures, and process improvements. The supervisor also evaluates and develops team members, supports hiring and onboarding, and serves as a contact for escalated issues. The position requires graduation from an accredited school of nursing or a bachelor's degree, at least four years of related experience, and the applicable independent-practice license. One of the specified professional licenses or certifications is required. Knowledge of behavioral health utilization management principles, prior supervisory experience, and understanding of medical necessity criteria for a broad range of behavioral health services are preferred. The position is remote. The annual pay range is $75,300 to $135,400. Centene offers competitive pay, health insurance, a 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and a flexible approach to work schedules. Actual pay may vary based on individual qualifications and other job-related factors; total compensation may include incentives, and benefits may depend on program eligibility.

Requirements

Graduate of an accredited school of nursing or bachelor's degree.
Four or more years of related experience.
License to practice independently and/or the state-required licensure applicable to the role.
One of the following is required: Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Licensed Marital and Family Therapist (LMFT), Licensed Mental Health Professional (LMHP), Registered Nurse (RN) with state or compact-state licensure, or Board Certified Behavior Analyst (BCBA) for ABA.

Nice To Haves

Knowledge of behavioral health utilization management principles.
Prior supervisory experience.
Understanding of medical necessity criteria for a broad range of behavioral health services.

Responsibilities

Monitor behavioral health utilization review clinicians and ensure compliance with applicable guidelines.
Monitor and track behavioral health utilization management resources to ensure adherence to performance, quality, and efficiency standards.
Work with the behavioral health utilization management team to resolve complex member issues related to behavioral health care.
Maintain knowledge of regulations, accreditation standards, and industry best practices related to behavioral health utilization management.
Work with the behavioral health utilization management team and senior management to identify process and quality improvement opportunities.
Educate and provide resources to the team on key initiatives and facilitate ongoing communication among the team, members, and providers.
Work with behavioral health senior management to develop and implement utilization management policies, procedures, and guidelines that support appropriate and effective healthcare service utilization.
Evaluate team performance and provide feedback on performance, goals, and career milestones.
Coach and guide the team to support optimal performance; provide counseling and corrective action when required.
Assist with onboarding, hiring, and training team members.
Attend company meetings in the absence of the people leader.
Serve as the primary contact for escalated calls and issues requiring research or special handling.
Lead and manage others in a matrixed or cross-functional environment.
Lead and champion change within the scope of responsibility.
Present information and respond to questions from peers, leaders, and internal and external customers.
Perform other duties as assigned.
Comply with all policies and standards.