Supervisor, Utilization Management

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.

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 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

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 :

Pay Range : $73,800.00 - $132,700.00 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.