Remote RN Leader, Utilization Management

Centene Corp.; New York (NY); Remote; USD 87,000 - 161,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a senior leader to manage Prior Authorization, Concurrent Review, and Appeals teams, ensuring appropriate care for members. The role requires an active RN license and a willingness to participate in weekend on-call coverage, with strong leadership, UM knowledge, and customer-service focus.

The position is remote, but candidates must reside in Oklahoma; you’ll collaborate with senior leadership, mentor staff, and drive process improvements in utilization management

Qualifications

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

Responsibilities

• Manages prior authorization, concurrent review, appeals, and retrospective reviews.
• Reviews utilization management activities and identifies improvement opportunities.
• Develops, implements, and maintains UM policies and procedures.
• Reviews UM reports to identify trends and provide recommendations to senior leadership.
• Maintains knowledge of regulations, accreditation standards, and best practices.
• Educates and provides resources for UM team and facilitates communication with members and providers.
• Collaborates with senior management to implement UM policies and guidelines.
• Provides coaching to UM team to ensure quality and performance.
• Assists leadership with onboarding, hiring, and training UM team members.
• Supports change initiatives within scope of responsibility.
• Performs other duties as assigned.

Skills

Computer literacy

Microsoft Office

Communication skills

Customer service

Time management

Education

Nursing degree

Bachelor's degree

Tools

Microsoft Office

Job description

Centene Corporation is seeking a senior leader to manage Prior Authorization, Concurrent Review, and Appeals teams, ensuring appropriate care for members. The role requires an active RN license and a willingness to participate in weekend on-call coverage, with strong leadership, UM knowledge, and customer-service focus.

The position is remote, but candidates must reside in Oklahoma; you’ll collaborate with senior leadership, mentor staff, and drive process improvements in utilization management