Remote Utilization Management Supervisor (RN Lead)

IntelliResume; Arizona; Remote; USD 75,000 - 135,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance.

You will supervise day-to-day UM operations, develop policies, and coach staff to achieve performance goals while staying current with regulatory standards and industry best practices.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.

Responsibilities

• Supervise day-to-day activities of the utilization management team.
• Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborate with the utilization management team to resolve complex care member issues.
• Maintain knowledge of regulations, accreditation standards, and industry best practices related to utilization management.
• Identify opportunities for process and quality improvements within utilization management.
• Educate and provide resources for the utilization management team on key initiatives.
• Monitor prior authorization, concurrent review, and/or retrospective clinical review nurses for compliance.
• Develop and implement UM policies, procedures, and guidelines.
• Evaluate utilization management team performance and provide feedback.
• Assist with onboarding, hiring, and training of utilization management team members.

Education

Bachelor's degree or Nursing program (Accredited School of Nursing)

Job description

Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance.

You will supervise day-to-day UM operations, develop policies, and coach staff to achieve performance goals while staying current with regulatory standards and industry best practices.