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Director, Clinical

Posted on Dec 8, 2018 by Centene Corporation

Florida, FL
Health Care
Immediate Start
Annual Salary


Position Purpose\: Oversee clinical functions in all service areas including\: intensive case management (ICM), utilization review (UR), provider training and care coordination. Responsible for clinical initiatives and oversight to ensure processes are consistent with URAC and NCQA guidelines as well as state mandates. Responsible for implementation of new business as appropriate including participation in RFP writing and in policy modification as needed for new lines of business Oversee the implementation of new lines of business. Develop clinical initiatives and monitor ICM, UR and disease management programs. Develop and maintain departmental policies and procedures. Develop program descriptions and evaluate programs to meet set guidelines. Ensure clinical initiatives are consistent with URAC, NCQA and state mandates. Coordinate with health plan Medical Management departments and clients.

  • Interface with network development and Quality Improvement.

  • Qualification:

    Education/Experience\: Master's degree in Behavioral Health or related field. 5+ years of related experience in utilization management or case management. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. License/Certification\: Unrestricted license as a LCSW, LMFT, LPC, LMHC, PhD, PsyD or RN licensed in applicable state(s).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.

    Reference: 600332913

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