RN Leader, Utilization Management — Remote

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements (remote, hy

Field or office work schedules

Job summary

Centene Corporation seeks an experienced nursing leader to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams. You will oversee day-to-day utilization management activities, monitor performance, and drive quality improvements while coaching staff.

The role requires a nursing degree with 4+ years of related experience and an active RN license; CMCN certification within 1.5 years is preferred.

Qualifications

• Requires nursing degree and 4+ years of related experience.
• Knowledge of utilization management principles preferred.
• RN license required; CMCN within 1½ years; federal clearance may be required

Responsibilities

• Supervises Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Monitors UM resources for performance, quality, and efficiency.
• Collaborates with UM team to resolve complex care issues.
• Identifies opportunities for process and quality improvements in UM.
• Provides coaching and onboarding for UM team members.
• Ensures adherence to guidelines, policies, and procedures.
• Leads change within responsibility scope and supports senior management.

Skills

Leadership

People management

Healthcare compliance

Education

Bachelor's degree

RN license

Job description

Centene Corporation seeks an experienced nursing leader to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams. You will oversee day-to-day utilization management activities, monitor performance, and drive quality improvements while coaching staff.

The role requires a nursing degree with 4+ years of related experience and an active RN license; CMCN certification within 1.5 years is preferred.