Supervisor, Utilization Management

Centene Corp.; Phoenix, Northern (AZ, KY); Hybrid; USD 75,000 - 135,000; Full time

Job summary

Centene Corp. seeks a highly experienced Supervisor, Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams.

You will oversee day-to-day operations, monitor performance metrics, and ensure adherence to guidelines to deliver appropriate care to members. In this role, you will collaborate with the UM team and senior leadership to drive policy improvements, educate staff on initiatives, and guide change across processes.

Qualifications

• RN license current and active in state (or compact).
• Bachelor’s degree in Nursing required.
• 4+ years in utilization management or clinical review.
• Knowledge of UM regulations and best practices.

Responsibilities

• Supervise Prior Authorization, Concurrent Review, and Retrospective Review teams.
• Monitor UM resources to ensure quality, compliance, and efficiency.
• Develop and implement UM policies and guidelines.
• Coach, onboard, hire, and train UM staff.
• Collaborate with management to identify process improvements.

Skills

RN licensure

Utilization management

Leadership

Coaching

Onboarding/training

Education

Bachelor's degree in Nursing

Job description

## Supervisor, Utilization ManagementApply: Remote-AZ: Vendor - Phoenix, AZ: Full time: Posted Today: 1662716**Position Purpose:** Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.* Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards* Collaborates with utilization management team to resolve complex care member issues* Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management* Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management* Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers* Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures* Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services* Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones* Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards* Assists with onboarding, hiring, and training utilization management team members* Leads and champions change within scope of responsibility* Performs other duties as assigned* Complies with all policies and standards**Education/Experience:** Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred. **License/Certification:** * 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 Yrs required* For Health Net Federal Services: US citizenship and current National Agency Check government security clearance requiredPay Range: $75,300.00 - $135,400.00 per year