Utilization Manager
3 weeks ago
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.
** Applicants for this role have the flexibility to work remotely from their home anywhere in the United States**
Position Purpose: Act as a subject matter expert (SME) in the utilization review and authorization of Durable Medical Equipment (DME) consistent with therapy practice and/or outpatient occupational, physical and speech therapy.
- Review for the medical necessity and appropriateness of Durable Medical Equipment based on policies and clinical guidelines.
- Authorize, direct and monitor care being provided in physical, occupational and speech therapy for medical necessity and appropriateness of care.
- Review plans of care to ensure functional outcomes and use of clinical practice guidelines.
- Ensure compliance with performance measures in regards to appeals and denials.
- Provide support and training to rehabilitation providers, including real time clinical training, consultation and guidance on matters related to service authorization, provision, and evidence based practices.
- Identify areas of concern with regards to deficiencies in the Plan of Care and make appropriate referrals and outreach to assist in improved treatment outcomes.
- Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.
- Performs other duties as assigned
- Complies with all policies and standards
3+ years of specialty therapy experience in Durable Medical Equipment provision and/or therapy services in inpatient, outpatient, or school settings required
AOTA - Occupational Therapy required or
APTA - Physical Therapy required or
SLP - Speech Language Practitioner required and: SPEECH - Speech Therapist – Certified Speech-Language Pathologists must also possess an active Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA) requiredPay Range: $ $58.31 per hour
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. Total compensation may also include additional forms of incentives.
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.
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