Supervisor, Utilization Management – RN

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $75.3k - $135.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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 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 care member issues • Maintain knowledge of utilization management regulations, accreditation standards, and industry best practices • Identify process and quality improvement opportunities with the utilization management team and senior management • Educate and provide resources to the utilization management team • 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 utilization management team • Assist with onboarding, hiring, and training team members • Lead and champion change within 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 • Knowledge of utilization management principles preferred • RN - Registered Nurse - State Licensure and/or Compact State Licensure required • CA RN Licensure required • Knowledge of utilization management regulations, accreditation standards, and industry best practices • Ability to supervise prior authorization, concurrent review, and/or retrospective clinical review nurses • Ability to ensure compliance with applicable guidelines, policies, and procedures

🏖️ 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