Supervisor, Utilization Management
Position Purpose
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.
Remote Role
Level III & IV NICU Bedside Experience preferred.
Responsibilities
- Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
- 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
- Assists with onboarding, hiring, and training utilization management team members
- Collaborates with utilization management team to resolve complex care member issues
- Makes sure UM resources are tracked and adhered to for performance, compliance, quality, and efficiency standards
- Monitors and ensures compliance with applicable guidelines, policies, and procedures for prior authorization, concurrent review, and/or retrospective clinical review nurses
- Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
- Works with the utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
- Works with the utilization management team to facilitate on-going communication between utilization management team, members, and providers
- Leads and champions change within scope of responsibility
Requirements
- Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience
- Knowledge of utilization management principles preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Qualifications
Complies with all policies and standards
Skills
Not specified
Benefits
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.
Pay
Not specified
Schedule
Flexible approach to work with remote, hybrid, field or office work schedules