Supervisor, Utilization Management

IntelliResume; Nevada (IA); 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 plus holidays

Flexible work schedules

Job summary

Centene is seeking a Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role is ideal for experienced nursing professionals looking to guide performance, compliance, and quality in a dynamic healthcare environment.

You will supervise day-to-day UM operations, monitor resources for efficiency, and collaborate to resolve complex member care issues while staying current with regulations and accreditation standards.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.
• 4+ years of related experience in utilization management.
• RN licensure in state or compact state 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 clinical review nurses and ensure compliance with applicable guidelines, policies, and procedures.
• Develop and implement UM policies, procedures, and guidelines with senior management.
• Evaluate utilization management team performance and provide feedback.
• Assist with onboarding, hiring, and training of team members.

Education

Bachelor's degree or Nursing degree

Job description

About This Role

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

Highlights

• Pay: $75,300 - $135,400/year
• Location: Remote, NV
• 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 clinical review nurses and ensure compliance with applicable guidelines, policies, and procedures.
• Develop and implement UM policies, procedures, and guidelines with senior management.
• Evaluate utilization management team performance and provide feedback.
• Assist with onboarding, hiring, and training of team members.

Requirements

Education:

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

Experience:

• 4+ years of related experience required.
• Knowledge of utilization management principles preferred.

Licenses & Certifications:

• RN - Registered Nurse - State Licensure and or Compact State Licensure required.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules

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 through meaningful challenges that support individuals, families, and communities.