Thea Palima-Rendall
Senior Director, Utilization Management @Centene Corporation
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WORK HISTORY
Senior Director, Utilization Management @Centene Corporation
Oversees utilization management operations for the health plan. Defines and directs the Utilization Management program for the plan in conjunction with corporate goals and objectives. Leads and directs the overall operation of the utilization management function to ensure consistency of policies, procedures and work flows. Evaluates utilization management program effectiveness and recommend improvements, including needs analysis and planning. Ensures provider satisfaction with utilization management program. Ensures utilization management targets for all products are met for the annual operating plan, state requirements and financial management. Ensures that utilization management process is integrated with case management program. Maintains compliance with National Committee for Quality Assurance (NCQA) standards for utilization management function. Develops and implements methods, policies and procedures to improve the departments efficiency and effectiveness. Identifies quality and risk management issues and facilitate the collection of information for quality improvement and reporting. Reviews various reports and identify trends to assist in financial forecasting.
EDUCATION
Jacksonville University
Master of Science, Nursing
Jacksonville University
Bachelor of Science, Nursing
Northern Marianas College
Associate of Science, Nursing
ABOUT THEA PALIMA-RENDALL
Experienced Healthcare Director with a demonstrated history of working in the health care…
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