Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Position Purpose: Plan and drive execution of Medical Management utilization programs, processes, and initiatives to ensure achievement of health benefit ratio targets, and appropriate reductions in utilization related expenses. Provide vision and strategic leadership for the development and implementation of compliant utilization management best practices across the enterprise while developing customized approaches for unique markets/product. Directs the collaboration within cross-functional teams to evaluate, refine, and advance the utilization management program and strategy Leads data-driven decision making to advance and improve the outcomes of utilization management teams Identifies and implements innovative solutions to improve the efficiency of utilization management processes across the enterprise Establishes standard operating procedures to drive consistency in utilization quality and service outcomes Designs data driven processes to identify areas of opportunity for improving outcomes and reducing costs Leads continuous development and improvement of policies, clinical guidelines, and aligned business practices across utilization management functions Innovates and implements new or revised models for UM operational functions in response to evolving trends in healthcare delivery and/or emerging models of care Ensures UM processes are compliant processes and adheres to regulatory requirements Defines and interprets key performance metrics to develop plans, mobilize the work force, and achieve the company’s UM goals Establishes and monitors service level agreements to ensure UM programs are meeting customer (health plan, corporate partner, etc.) needs Serves as a change agent, assisting others in understanding the importance, necessity, impact, and process of change through active involvement in decision making and coaching of leaders and staff Education/Experience: Bachelor's degree in Nursing or related healthcare field or equivalent experience. Masters in nursing or business preferred. 10 years of experience in managed care, health plan, or provider network organizations. Experience with Managed Medicaid preferred. License/Certification: Current nursing license Pay Range: $178,500.00 - $338,800.00 per year 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. Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email recruiting@centene.com. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.