Supervisor, Utilization Management

🔥 1 minute ago

🌵 Arizona, California, +6 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote 🐊 Florida – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🤠 Texas – 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 regulations, accreditation standards, and industry best practices related to utilization management • Identify process and quality improvement opportunities with the utilization management team and senior management • Educate and provide resources to the utilization management team on key initiatives • Facilitate ongoing communication between the utilization management 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 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

• Current California RN license required • Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience • Knowledge of appeals and utilization management principles • RN - Registered Nurse - State Licensure and/or Compact State Licensure required • For Health Net Federal Services: current and active licensure or certification that permits 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 • Must be available Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time • 3–5 years of direct experience managing appeals and strong understanding of utilization management principles within a managed care environment highly preferred

🏖️ Benefits

• Health insurance • 401K • 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