Supervisor, Behavioral Health Utilization Management

Centene Corporation•Remote-LA, LA

8d•$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. 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.

Requirements

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.
LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

Nice To Haves

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

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.
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.