Manager, Utilization Management

Centene Corporation; Oklahoma; Hybrid; USD 87,000 - 161,000; Full time

Benefits offered by this job

Remote work option

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corp. is seeking an experienced nurse leader in Oklahoma for a remote role overseeing Prior Authorization, Concurrent Review, Retrospective Review, and Appeals.

The position requires an active RN license and supervisory experience, with strong proficiency in Microsoft Office and excellent communication skills. The ideal candidate will guide utilization management, coordinate with providers, and ensure compliant, high-quality care for members.

Qualifications

• Bachelor's degree or nursing degree with 5+ years of related experience.
• 2+ years supervisory experience preferred.
• Knowledge of utilization management principles preferred.

Responsibilities

• Manage Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams to ensure appropriate member care.
• Oversee utilization management issues related to member care and provider interactions.
• Coordinate operations within utilization management to maintain efficiency and quality.

Skills

Healthcare leadership

Utilization management

Microsoft Office proficiency

Communication skills

Customer service

Education

Bachelor's degree

Nursing degree (RN)

Tools

Microsoft Office

Job description

Position Purpose:

Manages Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and facilitates operations within utilization management.

Key Details:

This is a remote position, but candidates must reside in Oklahoma and hold an active RN license. The ideal candidate must be willing to participate in weekend on-call coverage and have experience in healthcare leadership, utilization management, and managed care. Candidates should be computer-savvy and proficient in Microsoft Office applications, with excellent communication and customer service skills. Strong attention to detail, organizational and management abilities, and effective time management skills are also essential for success in this role.

Education/Experience:

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 5+ years of related experience.
• 2+ years supervisory experience preferred.
• Knowledge of utilization management principles preferred.

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $87,000.00 - $161,300.00 per year

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