Supervisor, Utilization Management

IntelliResume; Arizona; Remote; USD 75,000 - 135,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance.

You will supervise day-to-day UM operations, develop policies, and coach staff to achieve performance goals while staying current with regulatory standards and industry best practices.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.

Responsibilities

• Supervise day-to-day activities of the utilization management team.
• Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborate with the utilization management team to resolve complex care member issues.
• Maintain knowledge of regulations, accreditation standards, and industry best practices related to utilization management.
• Identify opportunities for process and quality improvements within utilization management.
• Educate and provide resources for the utilization management team on key initiatives.
• Monitor prior authorization, concurrent review, and/or retrospective clinical review nurses for compliance.
• Develop and implement UM policies, procedures, and guidelines.
• Evaluate utilization management team performance and provide feedback.
• Assist with onboarding, hiring, and training of utilization management team members.

Education

Bachelor's degree or Nursing program (Accredited School of Nursing)

Job description

About This Role

The Supervisor of Utilization Management oversees the Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team, ensuring appropriate care for members. This role is ideal for experienced nursing professionals looking to lead a team in a remote setting.

Highlights

• Pay: $75,300 - $135,400/year
• Location: Remote, AZ
• Schedule: Full Time, Day shift

What You’ll Do

• Supervise day-to-day activities of the utilization management team.
• Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborate with the utilization management team to resolve complex care member issues.
• Maintain knowledge of regulations, accreditation standards, and industry best practices related to utilization management.
• Identify opportunities for process and quality improvements within utilization management.
• Educate and provide resources for the utilization management team on key initiatives.
• Monitor prior authorization, concurrent review, and/or retrospective clinical review nurses for compliance.
• Develop and implement UM policies, procedures, and guidelines.
• Evaluate utilization management team performance and provide feedback.
• Assist with onboarding, hiring, and training of utilization management team members.

Requirements

Education:

• Graduate of an Accredited School of Nursing or Bachelor's degree required.

Experience:

• 4+ years of related experience required.

Licenses & Certifications:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• For Health Net Federal Services: Must have current and active licensure or certification that permits independent assessment required.
• For Health Net Federal Services (Medical Management): Certified Managed Care Nurse (CMCN) within 1-1/2 years required.
• For Health Net Federal Services: US citizenship and current National Agency Check government security clearance required.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidaysFlexible work schedules (remote, hybrid, field, or office work)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day.