Supervisor, Medical Management (Clinical)

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Supervisor, Medical Management (Clinical)

Position Purpose: Supervise the day-to-day operations of the medical management, utilization and case management functions for the corporate nursing clinical team and centralized transplant unit.

- Oversee daily operations of specific areas within the Medical Management department

- Assist senior management with input surrounding budgets and forecast for strategic planning and key initiatives. Balance current and future needs effectively.

- Ensure compliance with established work processes related to concurrent review, case management, referrals, pre-authorization policies, procedures, and processes

- Assure that Medical Management Operational Services functions and responsibilities are coordinated with other operating departments of health plans and Corporate teams

- Assist senior management with statistical analysis of utilization data

Education/Experience: Associates degree in Nursing or equivalent experience. Bachelors degree preferred.

3+ years nursing experience, case/utilization management or quality improvement in a healthcare environment, preferably managed care.

Licenses/Certifications: Current states RN license.

For Fidelis Care only: NYS unrestricted license as Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Physical Therapist (PT)

RN highly preferred.

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.

Clinical & Nursing

USA-New York-Getzville

USA-New York-Latham

Fidelis Care

  • 1
  • Negotiable
  • None
  • None
  • Re-184235
  • Permanent
  • 0

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