Remote Utilization Management Manager - RN Leader

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

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.