Supervisor, Utilization Management

Centene Corporation • Remote-NV, NV

1d • $75,300 - $135,400 • Remote

About The Position

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. This is a remote role. Candidates must possess a valid, active, and unrestricted Nevada Registered Nurse (RN) license. Willing to consider qualified candidates with a Compact RN license willing to apply for a Nevada RN License. The work schedule is Monday - Friday, 8 AM to 5 PM PST.

Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• Must possess a valid, active, and unrestricted Nevada Registered Nurse (RN) license or a Compact RN license willing to apply for Nevada RN License

Nice To Haves

• Knowledge of utilization management principles preferred

Responsibilities

• 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

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager