[Hiring] Supervisor, Utilization Management @Centene Corporation

Role Description

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.

• 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 ongoing 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.

Qualifications

• Graduate of an Accredited School Nursing or Bachelor's degree.
• 4+ years of related experience.
• Knowledge of utilization management principles preferred.

Requirements

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

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.

Company Description

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.