Supervisor, Utilization Management

🔥 12 hours ago

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $75.3k - $135.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 team • Supervise day-to-day activities of the utilization management team • Monitor and track UM resources for performance, compliance, quality, and efficiency • 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 team and senior management • Educate and provide resources 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 team members to meet quality and performance standards • Assist with onboarding, hiring, and training team members • Lead and champion change within the scope of responsibility • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience • Valid, active, and unrestricted Nevada Registered Nurse (RN) license required • Compact RN license may be considered if the candidate is willing to apply for a Nevada RN license • RN - Registered Nurse - State Licensure and/or Compact State Licensure required • Knowledge of utilization management principles preferred • Monday–Friday availability, 8AM to 5PM PST

🏖️ 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