Supervisor, Utilization Management

Centene Corp.; United States; Remote; 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 schedule

Job summary

Centene Corp. is seeking a nurse leader to supervise the Prior Authorization, Concurrent Review, and related utilization management functions from a remote location, while ensuring compliance and high-quality member care.

The role requires Oklahoma residency and an active RN license, with weekend on-call coverage and strong proficiency in Microsoft Office. The incumbent will guide day-to-day UM operations, coach staff, and collaborate with senior management to implement policies and drive

Qualifications

• RN license and state licensure required.
• 4+ years of related experience in utilization management.
• Residence in Oklahoma required.

Responsibilities

• Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborate with 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 utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers.
• Monitor prior authorization, concurrent review, retrospective clinical review and/or appeals nurses and ensure compliance with applicable guidelines, policies, and procedures.
• Develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services.
• Evaluate utilization management team performance and provide feedback regarding performance, goals, and career milestones.
• Provide coaching and guidance to utilization management team to ensure adherence to quality and performance standards.
• Assist with onboarding, hiring, and training utilization management team members.
• Lead and champion change within scope of responsibility.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

UM leadership

RN license

process improvement

MS Office

communication

team management

on-call readiness

Education

Nursing degree

Job description

Position Purpose:

Supervises Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.

Key Details:

This is a remote position; however, candidates must reside in Oklahoma and hold an active RN license. The ideal candidate must be willing to participate in weekend on-call coverage and have experience in utilization management. Candidates should be computer-savvy and proficient in Microsoft Office applications, with excellent communication and customer service skills. Strong attention to detail, organizational and management abilities, and effective time management skills are also essential for success in this role.

• 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, retrospective clinical review and/or appeals 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.

Knowledge of utilization management principles preferred.

Education/Experience:

Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.

License/Certification:

RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range:

$75,300.00 - $135,400.00 per year

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act