Supervisor, Behavioral Health Utilization Management

Centene Corporation•Remote-NC, NC

4d•$75,300 - $135,400•Remote

About The Position

Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. This is a remote position, but applicants must reside in North Carolina. The work schedule is Monday through Friday, 8:00 AM to 5:00 PM, with a rotating weekend on-call schedule. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 4+ years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
NC LCSW (Licensed Clinical Social Worker), LMHC (Licensed Mental Health Counselor), LPC (Licensed Professional Counselor), LMFT (Licensed Marital and Family Therapist), LMHP (Licensed Mental Health Professional), RN (Registered Nurse) with state licensure and/or compact state licensure, or BCBA (Board Certified Behavior Analyst) for ABA.
Reside in North Carolina.

Nice To Haves

Candidates with experience in technological proficiency, utilization management, leadership, communication, and customer service are preferred.
Knowledge of BH utilization management principles preferred.
Prior supervisory experience preferred.
Understanding of medical necessity criteria for a broad range of BH services preferred.

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.