Position Purpose:

Oversee and direct all clinical operations, including care management and coordination, and utilization management

• Establish the business unit’s clinical strategic vision, objectives, policies and procedures to ensure delivery of cost effective, clinically appropriate services in all markets.
• Monitor performance results against established metrics and benchmarks and recommend improvement opportunities.
• Serve as the subject matter expert and participate in all new implementations.
• Oversee utilization and care management across all markets.
• Participate in customer, health plan, and QI meetings.
• Oversee the production of reports required by the contract and management.
• Collaborate with various departments to resolve provider claims issues.
• Ensure effective care is delivered to members while achieving utilization management goals.
• Oversee annual budget for clinical operations.
• Drive efforts to increase staff expertise at shaping providers to perform more effectively in the delivery of care, including development of training programs.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

Master's Degree in Behavioral Health, Psychology, Public Health/Administration, related field or RN license required.
8+ years of clinical and operations experience in the behavioral health industry required.
Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN required.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act