Supervisor, Utilization Management

About the role

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.

Responsibilities

• Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to NICU members.
• Supervises day-to-day activities of utilization management team.
• Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management.
• Collaborates with utilization management team to resolve complex care member issues.
• Maintains and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management.
• Edits and provides resources for utilization management team on key initiatives and facilitates ongoing 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 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.
• Aids in onboarding, hiring, and training utilization management team members.
• Leads and champions change within scope of responsibility.
• Performs other duties as assigned.

Requirements

Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred. License/Certification RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

Qualifications

Remote Role: Level III & IV NICU Bedside Experience preferred.

Skills

Knowledge of utilization management principles preferred.

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.

Pay

$75,300.00 - $135,400.00 per year

Schedule

Remote Work Available