Centene Corporation
2 days ago Be among the first 25 applicants
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.
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 the 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
Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Pay Range $75,300.00 - $135,400.00 per year
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K 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.
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 Seniority level:
Not Applicable
Employment type:
Full-time
Job function:
Business Development and Sales
Industries:
Hospitals and Health Care and Insurance
Referrals increase your chances of interviewing at Centene Corporation by 2x
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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.
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 the 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
Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Pay Range $75,300.00 - $135,400.00 per year
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K 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.
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 Seniority level:
Not Applicable
Employment type:
Full-time
Job function:
Business Development and Sales
Industries:
Hospitals and Health Care and Insurance
Referrals increase your chances of interviewing at Centene Corporation by 2x
Get notified about new Management Supervisor jobs in
Nebraska, United States .
Associate Director, Neuroscience Priority Accounts – Great Plains Omaha, NE $160,300.00-$297,700.00 1 week ago
Travel - Interim Director of Nursing - Long Term Care We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr