RN Utilization Management Lead - Remote/Hybrid

Centene Management Company LLC; Arizona; Hybrid; USD 75,000 - 135,000; Full time

Job summary

Centene is seeking a RN/UM Supervisor to oversee Prior Authorization, Concurrent Review, and Retrospective Review teams, ensuring compliant and quality care for members. The role collaborates with the UM team and senior management to improve processes and educate staff on key initiatives.

The position supports remote, hybrid, field, or office work arrangements with a comprehensive benefits package and competitive compensation in line with experience and qualifications.

Qualifications

• Nursing leadership and UM expertise required.
• Knowledge of utilization management principles preferred.
• Strong coaching, communication, and change-management abilities.

Responsibilities

• Supervises Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Monitors UM resources to ensure performance, compliance, quality.
• Collaborates with UM team to resolve complex member issues.
• Develops and implements UM policies and guidelines.
• Provides coaching/feedback to UM staff and supports onboarding.
• Leads change initiatives within scope of responsibility.
• Ensures compliance with policies and standards.

Skills

Nursing leadership

Utilization management

Regulatory knowledge

Coaching and mentoring

Education

RN or BSN

Bachelor's degree in related field

Job description

Centene is seeking a RN/UM Supervisor to oversee Prior Authorization, Concurrent Review, and Retrospective Review teams, ensuring compliant and quality care for members. The role collaborates with the UM team and senior management to improve processes and educate staff on key initiatives.

The position supports remote, hybrid, field, or office work arrangements with a comprehensive benefits package and competitive compensation in line with experience and qualifications.