RN Lead, Utilization Management - Remote in Ohio

Centene Management Company LLC; Kentucky; Hybrid; USD 550 - 1,000; Full time

Benefits offered by this job

Competitive benefits

Remote/hybrid work options

Job summary

Centene Management Company LLC is seeking a Clinical UM leader to oversee Prior Authorization, Concurrent Review, and Retrospective Review teams in Ohio, with a focus on ensuring appropriate care for 28 million members. The role requires an active RN Ohio license and residency in Ohio, with some in-person attendance a few times per year.

The position emphasizes guiding utilization management operations, developing policies, and collaborating with senior leadership to drive improvements.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree with 5+ years related experience.
• 2+ years supervisory experience preferred.
• Knowledge of utilization management principles preferred.

Responsibilities

• Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members.
• Manages utilization management issues related to member care and provider interactions.
• Develops, implements, and maintains compliance with utilization management policies and procedures.
• Reviews utilization management reports to identify trends and provide recommendations to senior leadership.
• Educates and provides resources for utilization management team on key initiatives and to facilitate communication with members and providers.
• Leads and champions change within scope of responsibility and assists onboarding, hiring, and training of team members.

Skills

Utilization management

Team supervision

Coaching

Leadership

Education

Nursing degree (RN)

Job description

Centene Management Company LLC is seeking a Clinical UM leader to oversee Prior Authorization, Concurrent Review, and Retrospective Review teams in Ohio, with a focus on ensuring appropriate care for 28 million members. The role requires an active RN Ohio license and residency in Ohio, with some in-person attendance a few times per year.

The position emphasizes guiding utilization management operations, developing policies, and collaborating with senior leadership to drive improvements.