RN Supervisor, Appeals, Managed Care, UM

🕒 July 30

🏈 Alabama, Arizona, +20 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $75.3k - $135.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 21%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Supervise Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review teams • Supervise day-to-day activities of the utilization management team • Monitor and track UM resources for performance, compliance, quality, and efficiency standards • Collaborate with the utilization management team to resolve complex member care issues • Maintain knowledge of utilization management regulations, accreditation standards, and industry best practices • Identify process and quality improvement opportunities with the UM team and senior management • Educate and provide resources to the UM team on key initiatives and facilitate communication among the team, members, and providers • Monitor clinical review nurses and ensure compliance with applicable guidelines, policies, and procedures • Develop and implement UM policies, procedures, and guidelines with senior management • Evaluate team performance and provide feedback on performance, goals, and career milestones • Coach and guide the UM team to meet quality and performance standards • Assist with onboarding, hiring, and training UM team members • Lead and champion change within the scope of responsibility • Perform other assigned duties and comply with all policies and standards

🎯 Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience • Strong knowledge of appeals and utilization management principles preferred • 3–5 years of direct work experience and knowledge of the appeals process and utilization management principles in managed care/MCO environments preferred • RN – Registered Nurse – State Licensure and/or Compact State Licensure required • For Health Net Federal Services: current and active licensure or certification permitting independent assessment required • For Health Net Federal Services (Medical Management): Certified Managed Care Nurse (CMCN) within 1-1/2 years required • For Health Net Federal Services: US citizenship and current National Agency Check government security clearance required • Remote RN candidates may reside in any state, but a current and active California RN license is strongly preferred • California RN license background check and RN license approval required prior to starting this role

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity