Centene Corporation
Supervisor, Utilization Management
Centene Corporation, Iowa, Louisiana, United States, 70647
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.
Applicants for this role have the flexibility to work remotely from their home anywhere in the Central time zone. The role supervises Prior Authorization Nurses and is primarily Monday - Friday, with rotating weekend / holiday coverage.
Position Purpose Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day‑to‑day activities of utilization management team.
Responsibilities
Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
Collaborates with utilization management team to resolve complex care member issues
Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
Educates and provides resources for utilization management team on key initiatives and to facilitate 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
Assists with onboarding, hiring, and training utilization management team members
Leads and champions change within scope of responsibility
Performs other duties as assigned
Complies with all policies and standards
Education & Experience Graduate of an accredited school of nursing or bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred.
Licensing & Certification RN – Registered Nurse – State licensure and/or Compact State licensure required.
Pay Range $75,300.00 – $135,400.00 per year
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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. Benefits may be subject to program eligibility.
EEO Statement Centene is an equal‑opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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Applicants for this role have the flexibility to work remotely from their home anywhere in the Central time zone. The role supervises Prior Authorization Nurses and is primarily Monday - Friday, with rotating weekend / holiday coverage.
Position Purpose Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day‑to‑day activities of utilization management team.
Responsibilities
Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
Collaborates with utilization management team to resolve complex care member issues
Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
Educates and provides resources for utilization management team on key initiatives and to facilitate 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
Assists with onboarding, hiring, and training utilization management team members
Leads and champions change within scope of responsibility
Performs other duties as assigned
Complies with all policies and standards
Education & Experience Graduate of an accredited school of nursing or bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred.
Licensing & Certification RN – Registered Nurse – State licensure and/or Compact State licensure required.
Pay Range $75,300.00 – $135,400.00 per year
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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. Benefits may be subject to program eligibility.
EEO Statement Centene is an equal‑opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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