Supervisor, Utilization Management

About This Role

The Supervisor of Utilization Management oversees the Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team, ensuring appropriate care for members. This role is ideal for experienced nursing professionals looking to lead a team in a remote setting.

Highlights

• Pay: $75,300 - $135,400/year
• Location: Remote, AZ
• Schedule: Full Time, Day shift

What You’ll Do

• Supervise day-to-day activities of the utilization management team.
• Monitor and track UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborate with the utilization management team to resolve complex care member issues.
• Maintain knowledge of regulations, accreditation standards, and industry best practices related to utilization management.
• Identify opportunities for process and quality improvements within utilization management.
• Educate and provide resources for the utilization management team on key initiatives.
• Monitor prior authorization, concurrent review, and/or retrospective clinical review nurses for compliance.
• Develop and implement UM policies, procedures, and guidelines.
• Evaluate utilization management team performance and provide feedback.
• Assist with onboarding, hiring, and training of utilization management team members.

Requirements

Education:

• Graduate of an Accredited School of Nursing or Bachelor's degree required.

Experience:

• 4+ years of related experience required.

Licenses & Certifications:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• For Health Net Federal Services: Must have 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.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidaysFlexible work schedules (remote, hybrid, field, or office work)

About Centene

Centene is a leading healthcare provider committed to delivering exceptional patient care. They connect people to the care they need to live healthier lives, making a real impact every day.