RN Utilization Management Supervisor (CA) – Remote/Hybrid

Centene Corporation; California; Ibrido; USD 75.000 - 135.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules

Descrizione del lavoro

Centene Corporation is seeking an RN Supervisor to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams in California. The role ensures high-quality care for members and oversees daily UM operations with emphasis on staff performance and policy adherence.

Ideal candidates will have 3–5 years of direct UM leadership experience in a managed care setting, California RN licensure, and a strong grasp of appeals and utilization management principles.

Competenze

• Graduate of an Accredited School of Nursing or Bachelor's degree with 4+ years of related experience.
• Strong understanding of appeals and utilization management principles.

Mansioni

• Supervises Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Oversees day-to-day utilization management operations and staff.
• Ensures adherence to guidelines, policies, and procedures.
• Identifies opportunities for process and quality improvements in UM.
• Educates team and coordinates with providers and members.
• Onboards, trains, and coaches UM staff.
• Maintains knowledge of regulations and accreditation standards.

Conoscenze

UM leadership

Policy compliance

Coaching

Formazione

BSN or higher

Descrizione del lavoro

Centene Corporation is seeking an RN Supervisor to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams in California. The role ensures high-quality care for members and oversees daily UM operations with emphasis on staff performance and policy adherence.

Ideal candidates will have 3–5 years of direct UM leadership experience in a managed care setting, California RN licensure, and a strong grasp of appeals and utilization management principles.