Supervisor, Utilization Management

centene; United States; Hybrid; USD 75,000 - 135,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene is seeking a Senior Utilization Management Leader to supervise Prior Authorization, Concurrent Review, and Retrospective Review teams, ensuring appropriate care for members. This role oversees day-to-day UM operations and collaborates with senior management to drive performance.

Requires RN licensure and a Bachelor's degree with 4+ years in utilization management or related fields. The position supports remote, hybrid, or field/office work arrangements and offers a comprehensive benefits

Qualifications

• Graduate of an Accredited School of Nursing or a Bachelor's degree with 4+ years of related experience.
• RN - State Licensure required.

Responsibilities

• Monitors UM resources to ensure adherence to standards.
• Collaborates with UM team to resolve care issues.
• Maintains knowledge of regulations and accreditation standards.
• Identifies opportunities for process and quality improvements in UM.
• Educates and provides resources for UM staff on key initiatives.
• Leads and coaches UM nurses to ensure quality and performance.
• Oversees onboarding, hiring, and training of UM staff.
• Ensures compliance with policies and procedures.

Education

Bachelor's degree in Nursing

Job description

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.

Key Details:

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

• 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.

License/Certification:

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

Pay Range:

$75,300.00 - $135,400.00 per year

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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