Full-Time

VP – PHCO Utilization Management

Medicare & Duals

Confirmed live in the last 24 hours

Centene

Centene

10,001+ employees

Provides health insurance and services

Healthcare

Compensation Overview

$182.1k - $345.6kAnnually

+ Incentives

Expert

Remote in USA

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary

You match the following Centene's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Bachelor's degree in Nursing, related field or equivalent experience
  • 10+ years of nursing, utilization management, or case management experience in an acute care setting
  • Experience in managed care environment
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
  • Current state’s nursing license
Responsibilities
  • Oversee the operations of utilization management, reconciliation coordination, concurrent review (telephonic and on-site), specialty therapy programs and other related functions across multiple product lines in both centralized and multi-site regional environments
  • Oversee the development and implementation of centralized and multi-site regional clinical and non-clinical training programs
  • Provide strategic and tactical leadership and support to provider relations issues related to utilization issues for hospitals and physician providers
  • Oversee coordination efforts with member services and the connections departments to address concerns regarding compliance with medical management requirements
  • Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions, prior authorization and concurrent review units
  • Collaborate with upper management to implement and maintain policies and procedures regarding the prior authorization and concurrent review functions across multiple product lines and overseen by multiple regulatory agencies
  • Oversee processes used to assess quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes
  • Review various reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting

Centene Corporation provides health insurance and services primarily to underinsured and uninsured individuals in the United States. The company offers a range of products, including medical, dental, vision, and behavioral health services, using a localized approach to meet community needs. Centene stands out from competitors by focusing on cost-effective, high-quality care and addressing social barriers to health. Its goal is to improve health outcomes while ensuring employee well-being and corporate sustainability.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Centene's membership increased by 12% in Marketplace and 50% in Medicare PDP in 2024.
  • The expansion of low-cost plans like Fidelis Care's Essential Plan increases healthcare accessibility.
  • Centene's ICHRA plans offer customizable and transparent health insurance options.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may pressure Centene's market share.
  • Reliance on government contracts exposes Centene to political and policy changes.
  • Natural disasters and new health threats could strain Centene's operational capabilities.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company offers a wide range of health insurance products through local brands.
  • Centene focuses on cost-effective, high-quality care for underinsured and uninsured individuals.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours