Manager, Utilization Management

Centene
Ohio
Workplace: RemoteFull timeUSD 87,000 - 161,300 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 5+ yearsEducation: bachelorsSkills: ["Leadership","Coaching","Compliance","Analysis"]

Manage a utilization management (UM) team overseeing prior authorization, concurrent review, and/or retrospective review to support appropriate member care. Lead team performance and coaching, ensure compliance with UM policies, regulations, and accreditation standards, and analyze UM activities, operations, costs, and forecasts to identify improvement opportunities. Provide recommendations to senior leadership and support onboarding, hiring, and training while maintaining ongoing communication with members and providers.

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FursaFursa
Centene
Centene
2 days ago

Manager, Utilization Management

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Manage a utilization management (UM) team overseeing prior authorization, concurrent review, and/or retrospective review to support appropriate member care. Lead team performance and coaching, ensure compliance with UM policies, regulations, and accreditation standards, and analyze UM activities, operations, costs, and forecasts to identify improvement opportunities. Provide recommendations to senior leadership and support onboarding, hiring, and training while maintaining ongoing communication with members and providers.
Location: Ohio
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Manage a prior authorization, concurrent review, and/or retrospective clinical review team to ensure appropriate care for members.
  • •Ensure compliance with applicable guidelines, policies, and procedures across utilization management operations.
  • •Review and analyze utilization management activities, operations, costs, and forecasted data to identify improvement areas.
  • •Develop, implement, and maintain utilization management policies and procedures, and provide trend-based recommendations to senior leadership.
  • •Coach and guide the UM team to meet quality and performance standards; assist with onboarding, hiring, and training.
Travel: Low travel

Pay and Benefits

Salary: USD 87,000 - 161,300 annually
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Graduate of an accredited school of nursing or Bachelor's degree and 5+ years of related experience.
  • •Candidates must reside in Ohio and hold an active RN Ohio license.
  • •RN - Registered Nurse state licensure and/or Compact State Licensure required.
  • •2+ years supervisory experience preferred.
  • •Knowledge of utilization management principles preferred.
Experience:5+ yearsHealthcareUtilization management
Education:Bachelor's
Skills:LeadershipCoachingComplianceAnalysis
Licenses:RN - Registered Nurse (Ohio)Compact State Licensure

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn