Remote Utilization Management Supervisor (RN)

Centene Corporation; Missouri; Hybrid; USD 75,000 - 135,000; Full time

Job summary

Centene Corporation is seeking an RN leader to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams within the Utilization Management function, ensuring compliant and high-quality care for members.

This remote-eligible role requires an RN license, a nursing degree, and 4+ years of related experience, with cross-functional collaboration across senior management to improve processes and outcomes.

Qualifications

• Requires Nursing degree (RN) or equivalent and 4+ years of related experience.
• Knowledge of utilization management principles preferred.

Responsibilities

• 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.
• Works with UM team and senior management to identify opportunities for process and quality improvements within UM.
• Educates UM team on key initiatives and facilitates communication with members and providers.
• Monitors prior authorization, concurrent review, and retrospective reviews and ensures compliance with guidelines.
• Develops and implements UM policies and guidelines with senior management.
• Evaluates UM team performance and provides feedback on goals and milestones.
• Coaches and guides UM team to maintain quality and performance standards.
• Assists with onboarding, hiring, and training UM team members.
• Leads and champions change within scope of responsibility.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Nursing leadership

Utilization management

Team coaching

Education

Nursing degree (RN) or equivalent

Job description

Centene Corporation is seeking an RN leader to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams within the Utilization Management function, ensuring compliant and high-quality care for members.

This remote-eligible role requires an RN license, a nursing degree, and 4+ years of related experience, with cross-functional collaboration across senior management to improve processes and outcomes.