Supervisor, Utilization Management at Centene

**Who this is for** This supervisory role is for experienced Registered Nurses with a strong background in utilization management and a passion for leading clin

Work type: remote

Location: Remote-NY

Salary: $75,300 – $135,400/yr

Type: Full-time

Summary

**Who this is for** This supervisory role is for experienced Registered Nurses with a strong background in utilization management and a passion for leading clinical teams. If you are adept at ensuring appropriate patient care and possess excellent leadership and communication skills, this is an exciting opportunity. **Key highlights** You will supervise a team responsible for prior authorization, concurrent review, and retrospective review, ensuring adherence to performance, quality, and compliance standards. This fully remote role based in New York allows you to lead a critical function from anywhere. **You might be a good fit if you...** - Are a Registered Nurse with a valid New York RN licensure and a Bachelor's degree or equivalent experience. - Have 4+ years of related experience in utilization management and a solid understanding of its principles. - Possess experience in supervising clinical teams, monitoring performance, and providing coaching. - Are knowledgeable about healthcare regulations, accreditation standards, and best practices in utilization management.

Job Description

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.
 

All applicants must have New York RN licensurePosition 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 on-going 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

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.

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