Remote Utilization Management Nurse Leader
Centene Corporation
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Job summary
Centene Corporation in Nevada is seeking an RN leadership role to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams in a remote capacity. The position requires an active Nevada RN license (or a compact license with eligibility to obtain Nevada licensure) and a nursing degree with 4+ years in utilization management.
The role operates Monday–Friday, 8AM–5PM PST, with compensation reflecting the remote, full-time scope and the need for regulatory knowledge and team
Qualifications
- RN license in Nevada or Compact with Nevada license.
- Bachelor's degree in nursing.
- 4+ years of related experience in utilization management or clinical review.
- Graduate of Accredited Nursing School.
Responsibilities
- Oversees Prior Authorization and Review teams to ensure appropriate care.
- Monitors UM resources for quality, compliance, and efficiency.
- Collaborates with UM team to resolve complex member issues.
- Develops and implements UM policies and guidelines.
- Onboards and trains UM staff; provides coaching and feedback.
- Keeps current with regulations and accreditation standards in UM.
- Leads process improvements and communicates with members and providers.
- Ensures adherence to policies and standards.
Skills
Education
Job description
Centene Corporation in Nevada is seeking an RN leadership role to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams in a remote capacity. The position requires an active Nevada RN license (or a compact license with eligibility to obtain Nevada licensure) and a nursing degree with 4+ years in utilization management.
The role operates Monday–Friday, 8AM–5PM PST, with compensation reflecting the remote, full-time scope and the need for regulatory knowledge and team
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