Director, Utilization Management Hospice CoE

Centene Corporation

Job Overview

Location

Remote-MO

Job Type

Full-time

Full Job Description

📋 Description

• Directs the utilization management team to ensure the appropriate application of policy procedures and processes to help support best member outcomes.
• Oversees and manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider interactions and experience and associated regulatory and/or compliance measures.
• Leads utilization management team on performance, improvement, and career growth path considerations.
• Leads utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards.
• Reviews, analyzes, and reports on utilization trends, patterns, and impacts to deliver an effective utilization program.
• Leads process improvements for the utilization management team to achieve cost-effective healthcare results and presents to senior leadership team.
• Establishes policies and procedures that incorporate best practices and ensure effective utilization reviews of members.
• Develops utilization management strategies and influences decisions by providing recommendations that align to organizational objectives.
• Responsible for components of the department’s budget while collaborating inter-departmentally with senior leadership.
• Executes the overall strategy for onboarding, hiring, and training new utilization management team members to ensure adequate training and high quality-care to improve member and provider experience and ensure compliance.
• Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines.
• Leads and champions change within scope of responsibility.
• Performs other duties as assigned.
• Complies with all policies and standards.

🎯 Requirements

• Requires a Bachelor’s degree and 7+ years of related experience, including prior management experience.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
• 4+ years management experience preferred.
• Expert knowledge of industry regulations, policies, and standards preferred.

🏖️ Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

Skills & Technologies

Remote

Degree Required

Ready to Apply?

Apply Externally

You will be redirected to an external site to apply.

AI Job Fit Analysis

Pro

See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.

Centene Corporation

Visit Website

About Centene Corporation

Centene Corporation is a publicly traded managed-care enterprise that arranges health-benefit programs for government-sponsored and privately insured individuals. Operating across all 50 U.S. states and internationally, the company focuses on under-insured and uninsured populations through Medicaid, Medicare, and Marketplace offerings. Its services include behavioral health, pharmacy benefits, vision, dental, telehealth, and in-house clinical programs. Centene partners with physicians, hospitals, and community organizations to coordinate cost-effective care, emphasizing data analytics and value-based reimbursement models. Headquartered in St. Louis, Missouri, it serves more than 25 million members, positioning itself as a leading intermediary between payers and healthcare providers.

View Company Profile

Get more remote jobs like this

Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.

Weekly remote jobs and featured talent.

No spam. Only curated remote roles and product updates. You can unsubscribe anytime.