Supervisor, Utilization Management

Centene Corporation

1d

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. All applicants must have New York RN licensure. This position supervises the Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Centene is committed to helping people live healthier lives by providing access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree
• 4+ years of related experience
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• All applicants must have New York RN licensure

Nice To Haves

• Knowledge of utilization management principles preferred

Responsibilities

• 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.

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees