RN - Supervisor, Utilization Management

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

Job summary

A leading healthcare organization is seeking a supervisor for its Medical Management/Health Services team. This fully remote role involves overseeing concurrent review nurses, ensuring compliance with utilization management standards, and fostering team performance. Candidates should have a nursing background and experience in acute care mental health settings.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 4+ years of related experience in utilization management.
• Knowledge of regulations and accreditation standards.
• RN - Registered Nurse - State Licensure required.

Responsibilities

• Supervises day-to-day activities of utilization management team.
• Monitors and tracks UM resources for compliance and quality.
• Collaborates with team to resolve complex care member issues.

Skills

Utilization management principles

Leadership

Collaboration

Education

Graduate of an Accredited School Nursing or Bachelor's degree

Job description

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