Manager, Utilization Management

Centene Corp.; Oklahoma; Remote; USD 87,000 - 161,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,hybrid

Job summary

Centene Corp. is seeking a Manager of Utilization Management to oversee Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams.

This remote role requires a clinical leader with strong UM experience and Oklahoma residency. You will develop, implement, and maintain UM policies, analyze utilization data for improvements, and coach staff while partnering with senior management on policy guidelines.

Qualifications

• RN licensure in state or compact state.
• Minimum 5 years in utilization management with 2+ years in supervision.
• Experience ensuring compliance with guidelines and policies.

Responsibilities

• Manage prior authorization, concurrent review, appeals, and retrospective clinical review teams.
• Ensure compliance with applicable guidelines, policies, and procedures.
• Review utilization management activities to identify areas for improvement.
• Develop and maintain UM policies and procedures.
• Review UM reports to identify trends and provide recommendations.
• Provide coaching and guidance to the UM team.
• Assist with onboarding, hiring, and training of team members.

Skills

Healthcare leadership

Utilization management principles

Coaching and development

Education

Graduate of Accredited School of Nursing

Bachelor's degree

Job description

About This Role

The Manager of Utilization Management oversees the Prior Authorization, Concurrent Review, Retrospective Review Clinical Review, and Appeals teams to ensure appropriate care for members. This remote position is ideal for candidates with healthcare leadership experience and a strong background in utilization management.

Highlights

• Pay: $87,000 - $161,300/year
• Location: Remote, OK
• Residency: Must reside in Oklahoma
• Schedule: Full Time, Day shift

What You'll Do

• Manage prior authorization, concurrent review, appeals, and/or retrospective clinical review team.
• Ensure compliance with applicable guidelines, policies, and procedures.
• Review and analyze utilization management activities to identify areas for improvement.
• Develop, implement, and maintain compliance with utilization management policies and procedures.
• Review utilization management reports to identify trends and provide recommendations.
• Maintain knowledge of processes, regulations, and industry best practices.
• Educate and provide resources for the utilization management team on key initiatives.
• Work with senior management to develop and implement UM policies and guidelines.
• Provide coaching and guidance to the utilization management team.
• Assist with onboarding, hiring, and training of team members.

Requirements

Education:

• Graduate of an Accredited School of Nursing or Bachelor's degree required

Experience:

• 5+ years of related experience required
• 2+ years supervisory experience preferred
• Knowledge of utilization management principles preferred

Licenses & Certifications:

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

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules (remote, hybrid, field, or office work)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day through meaningful challenges and a dedicated team.