RN Utilization Management Supervisor – Lead Appeals

Centene Corporation; New Mexico; On-site; USD 75,000 - 135,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Corporation seeks an RN Supervisor to lead Prior Authorization, Concurrent Review, and Retrospective Review teams in support of California members. The role requires a California RN license and oversight of CA-based staff, with a Monday–Friday, 8:00 a.m. to 5:00 p.m.

Pacific Time schedule. Ideal candidates have 3–5 years of direct experience in appeals and utilization management within managed care, and a strong understanding of UM principles.

Qualifications

• Graduate of an accredited nursing program with 4+ years in UM/appeals.
• RN license in applicable state; California license required if overseeing CA staff.
• Strong knowledge of utilization management in managed care.

Responsibilities

• Supervises Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Monitors UM resources to meet performance, compliance, quality, and efficiency standards.
• Collaborates with UM team to resolve complex care issues for members.
• Keeps current with regulations, accreditation standards, and industry best practices.

Skills

Leadership

Team management

Utilization management

Regulatory knowledge

Education

Bachelor's degree in Nursing

Tools

EHR systems

Compliance tracking software

Job description

Centene Corporation seeks an RN Supervisor to lead Prior Authorization, Concurrent Review, and Retrospective Review teams in support of California members. The role requires a California RN license and oversight of CA-based staff, with a Monday–Friday, 8:00 a.m. to 5:00 p.m.

Pacific Time schedule. Ideal candidates have 3–5 years of direct experience in appeals and utilization management within managed care, and a strong understanding of UM principles.