Job Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
**Position Purpose:** Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
+ Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
+ Collaborates with utilization management team to resolve complex care member issues
+ Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
+ Works with utilization management team and senior management to identify opportunities for process and quality improvements within utili...
**Position Purpose:** Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
+ Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
+ Collaborates with utilization management team to resolve complex care member issues
+ Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
+ Works with utilization management team and senior management to identify opportunities for process and quality improvements within utili...
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