Director, Utilization Management Authorization and Claims

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: 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. Oversees the end-to-end management of authorization reconciliation and post claim authorization functions, ensuring seamless coordination between authorization processes, claims reconciliation, and provider case resolution. This role focuses on optimizing operational workflows,...