Supervisor, Utilization Management

Centene Corporation

1d • Remote

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. Centene is hiring a Remote Registered Nurse Supervisor – Utilization Management (Dual Program). The ideal candidate will have prior experience in utilization management, including prior authorization and concurrent review, along with previous leadership or supervisory experience, and knowledge of LTSS programs. A compact RN license is required. This is a remote position with standard business hours, Monday through Friday, 8:00 AM–5:00 PM, with potential for weekend, holiday, and on-call coverage. Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members.

Requirements

• Requires 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

Nice To Haves

• Knowledge of utilization management principles preferred.
• prior experience in utilization management, including prior authorization and concurrent review, along with previous leadership or supervisory experience, and knowledge of LTSS programs

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

• 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.

What This Job Offers

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