RN Utilization Management Supervisor (Remote)

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

Benefits offered by this job

Health insurance

401K & stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a Nurse Leader to supervise the Utilization Management team, overseeing prior authorization, concurrent and retrospective reviews. The role ensures adherence to policies, quality standards, and regulatory requirements while coordinating with senior management and providers.

The candidate should have a nursing degree and 4+ years of related experience, with strong knowledge of appeals and UM principles.

Qualifications

• Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
• Strong knowledge of appeals and utilization management principles preferred.
• 3-5 years of direct work experience and knowledge of appeals processes in managed care environments preferred.

Responsibilities

• Supervises Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Monitors UM resources to ensure adherence to performance and quality standards.
• Educates and provides resources for UM team on key initiatives.
• Coaches and guides UM staff to ensure adherence to guidelines and quality.
• Onboards, hires, and trains UM team members.
• Develops and implements UM policies and procedures.

Skills

Leadership

Coaching

Educating

Onboarding

Training

Education

Bachelor's degree in Nursing

Graduate of an Accredited School of Nursing

Job description

Centene Corporation is seeking a Nurse Leader to supervise the Utilization Management team, overseeing prior authorization, concurrent and retrospective reviews. The role ensures adherence to policies, quality standards, and regulatory requirements while coordinating with senior management and providers.

The candidate should have a nursing degree and 4+ years of related experience, with strong knowledge of appeals and UM principles.