RN Utilization Management Supervisor | Lead Care Review

Centene Corporation; United States; Hybrid; USD 75,000 - 135,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off & holidays

Flexible work schedules

Job summary

Centene Corporation is seeking a nurse leader to supervise the Prior Authorization, Concurrent Review, and Retrospective Review teams, ensuring optimal utilization of healthcare services. You will guide day-to-day UM operations, track performance metrics, and drive quality improvements across the UM function.

You will lead staffing, training, and compliance efforts, collaborating with senior management to align policies with regulatory standards and best practices in utilization management.

Qualifications

• Requires RN licensure and state licensure (CA preferred).
• Experience supervising utilization management teams.

Responsibilities

• Supervise Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Monitor UM resources to meet performance, compliance, quality, and efficiency standards.
• Collaborate with UM team to resolve complex member issues.
• Develop and implement UM policies and guidelines; ensure staff adherence to guidelines.
• Provide coaching, onboarding, and training for UM staff; lead change initiatives.

Skills

Leadership

Process improvement

Team management

Regulatory knowledge

Education

Bachelor's degree in Nursing

Job description

Centene Corporation is seeking a nurse leader to supervise the Prior Authorization, Concurrent Review, and Retrospective Review teams, ensuring optimal utilization of healthcare services. You will guide day-to-day UM operations, track performance metrics, and drive quality improvements across the UM function.

You will lead staffing, training, and compliance efforts, collaborating with senior management to align policies with regulatory standards and best practices in utilization management.