Senior Director, Utilization Management Strategy & Innovation

Position Purpose: Oversight of our national Gold Card Program ensuring effective performance and communication of strategic priorities and outcomes with stakeholders.

Key Details: Lead the strategy and growth of our national Gold Card Program designed to simplify utilization management for eligible providers. Drive innovative initiatives that streamline provider interactions, enhance the provider experience, and support more efficient healthcare delivery. Partner across clinical, operational, regulatory, and technology teams to deliver measurable impact.

Responsibilities:

• Develop and execute the strategic vision for the national Gold Card Program.
• Identify opportunities to simplify provider interactions and improve healthcare delivery through innovative approaches to utilization management.
• Drive adoption and expansion strategies across multiple products and markets.
• Oversee outcomes related to provider experience, operational efficiency, compliance, and business value.
• Monitor industry trends, emerging regulations, and best practices related to utilization management and provider burden reduction to inform program operations.
• Foster a culture of accountability, innovation, collaboration, and continuous improvement.

Highly Preferred Skills:

• Experience developing and executing strategic initiatives with measurable business outcomes.
• Demonstrated success leading large-scale transformation efforts across matrixed organizations.
• Strong executive presence with exceptional communication and stakeholder management skills.
• Experience working with cross-functional teams spanning clinical, operational, regulatory, and technology functions.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 7+ years of product development/management or related experience. Experience with product planning, development, execution, and product financials. Experience across different market segments and product types.

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