Remote RN Supervisor — Utilization Management

Centene Corporation; California (MO); Hybrid; USD 75,000 - 135,000; Full time

Job summary

Centene Corporation in California seeks a Supervising Clinician to lead the Prior Authorization and Utilization Management teams, ensuring compliant, high-quality care for members.

This role requires an RN license, a nursing degree, and 4+ years of related experience, with strong knowledge of appeals and UM principles. It emphasizes coaching, onboarding, and process improvement within a dynamic managed care environment.

Qualifications

• Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
• Strong knowledge of appeals and utilization management principles preferred.

Responsibilities

• Supervises Prior Authorization, Concurrent Review, and Retrospective Review teams to ensure appropriate care to members.
• Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborates with utilization management team to resolve complex care member issues.
• Maintains knowledge of 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 ongoing communication between utilization management team, members, and providers.
• Monitors prior authorization, concurrent review, and retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures.
• Works with senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services.
• Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones.
• Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards.
• Assists with onboarding, hiring, and training utilization management 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

Coaching

Onboarding

Healthcare policies

Education

Bachelor's degree in Nursing

RN license

CMCN / CMN certification

Job description

Centene Corporation in California seeks a Supervising Clinician to lead the Prior Authorization and Utilization Management teams, ensuring compliant, high-quality care for members.

This role requires an RN license, a nursing degree, and 4+ years of related experience, with strong knowledge of appeals and UM principles. It emphasizes coaching, onboarding, and process improvement within a dynamic managed care environment.