RN - Supervisor, Utilization Management

Centene Corporation; Orlando (FL); Remote; USD 73,000 - 133,000; Full time

Job summary

A leading healthcare organization seeks an RN Supervisor for Utilization Management. This fully remote role involves supervising a team of nurses, ensuring compliance with standards, and collaborating on care issues. Ideal candidates have experience in acute care mental health and utilization management.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Requires 4+ years of related experience.
• Knowledge of utilization management principles preferred.

Responsibilities

• Supervises Prior Authorization and Concurrent Review Clinical Review team.
• Monitors and tracks UM resources for compliance and quality standards.
• Collaborates with team to resolve complex care member issues.

Skills

Utilization Management

Acute Care Mental Health

Education

Bachelor's degree

Job description

Join to apply for the RN - Supervisor, Utilization Management role at Centene Corporation

1 day ago Be among the first 25 applicants

Join to apply for the RN - Supervisor, Utilization Management role at Centene Corporation

Get AI-powered advice on this job and more exclusive features.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

• NOTE This is a fully remote role supervising a team of concurrent review nurses. Preference will be given to applicants (1) who reside in either central or eastern time zone, (2) with experience in acute care mental health settings, and (3) utilization management / review.
• Department Ambetter Utilization Management / Inpatient Florida / Concurrent Reviews
• Business Unit Corporate
• Schedule Monday through Friday 8-5 PM ET / 7-4 PM or 8-5 PM CT; plus occasional on-call weekends and holiday rotation.****
  
  

Position Purpose Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.

• 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 utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
• Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
• Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
• Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
• Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
• Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
• Assists with onboarding, hiring, and training utilization management team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned
• Complies with all policies and standards
  
  

Education/Experience Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.

Knowledge of utilization management principles preferred.

License/Certification

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
  
  

Pay Range $73,800.00 - $132,700.00 per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Insurance

Referrals increase your chances of interviewing at Centene Corporation by 2x

Sign in to set job alerts for “Nursing Manager” roles.

Manager, Case Management - Aetna Better Health of Florida - Registered Nurse

Remote Registered Nurse (RN) Case Manager

On-Call Registered Nurse (RN) Remote 1099 Contractor

Registered Nurse (RN) - Assisted Living/Skilled Nursing- Pick Your Own Schedule - $30-45/hr with Bonuses

Pool Registered Nurse Auditor, Revenue Integrity, Per Diem, Local Remote Sat/Sun

Registered Nurse Utilization Review, Care Coordination, Bethesda East, FT, 08A-4:30P Local REMOTE

Registered Nurse - RN - Ortho Full Time Nights

West Palm Beach, FL $26.00-$30.00 3 months ago

Call Center: Telecare Registered Nurse (RN)

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.