Remote RN Leader — Utilization Management

Centene Corporation; Enid (OK); 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 and holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Nurse Leader to manage Prior Authorization, Concurrent Review, and related UM activities. The role requires Oklahoma residency with an active RN license and offers remote work with weekend on-call coverage.

Ideal candidates will have healthcare leadership experience, strong Microsoft Office skills, and a focus on patient care, quality, and efficiency. Supervisory experience is preferred, with a commitment to ongoing training and policy development.

Qualifications

• 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.

Responsibilities

• Manages prior authorization, concurrent review, appeals, and/or retrospective clinical review team and ensures compliance with applicable guidelines, policies, and procedures
• Reviews utilization management activities, operations, costs, and forecasted data to identify areas for improvement within UM
• Develops, implements, and maintains compliance with utilization management policies and procedures
• Reviews utilization management reports to identify trends and provide recommendations to senior leadership
• Maintains knowledge of processes, regulations, accreditation standards, and industry best practices related to utilization management
• Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
• Works with the senior management team to develop and implement UM policies, procedures, and guidelines
• Works with UM senior management to provide updates on team goals and objectives
• Provides coaching and guidance to UM team to ensure adherence to quality and performance standards
• Assists UM senior leadership with onboarding, hiring, and training UM team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Leadership

Utilization management

Healthcare leadership

Microsoft Office

Communication

Customer service

Attention to detail

Education

Bachelor's degree

RN license

Tools

Microsoft Office

Job description

Centene Corporation seeks a Nurse Leader to manage Prior Authorization, Concurrent Review, and related UM activities. The role requires Oklahoma residency with an active RN license and offers remote work with weekend on-call coverage.

Ideal candidates will have healthcare leadership experience, strong Microsoft Office skills, and a focus on patient care, quality, and efficiency. Supervisory experience is preferred, with a commitment to ongoing training and policy development.