Remote RN Leader, Utilization Management & Compliance

Centene Management Company LLC

Oklahoma

Hybrid

USD 87,000 - 161,000

Full time

4 days ago

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Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules

Job summary

Centene Management Company LLC is seeking a Nurse leader to manage Prior Authorization, Concurrent Review, and related utilization management activities. This remote US-based role requires Oklahoma residency and an active RN license, with weekend on-call coverage.

Strong MS Office proficiency, communication, and organizational skills are essential for success. The role emphasizes guiding UM team to ensure compliant, efficient care, with opportunities to influence policy and process improvements

Qualifications

Graduate of an Accredited School of Nursing or BSN required.
Minimum 5+ years of related experience in healthcare/utilization management.
2+ years supervisory experience preferred.
RN license required in-state or compact state.

Responsibilities

Manages Prior Authorization, Concurrent Review, Appeals, and retrospective clinical review teams.
Reviews utilization management activities, costs, and forecast data to identify improvements.
Develops and maintains UM policies and procedures.
Provides coaching and guidance to UM team to ensure quality and performance.
Onboards, hires, and trains UM team members.
Leads change within scope of responsibility.
Ensures compliance with applicable guidelines, policies, and procedures.