Supervisor, Utilization Management (RN)

Centene
California, Missouri
Workplace: RemoteFull timeUSD 75,300 - 135,400 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 4+ yearsEducation: bachelorsSkills: ["Communication","Leadership","Problem-solving"]

Lead and mentor the Utilization Management team (Prior Authorization, Concurrent Review, and Retrospective Review) to ensure appropriate care for members. Manage day-to-day UM operations, monitor performance and compliance, drive process improvements, and coach staff on policies, guidelines, and regulatory standards within a remote-capable healthcare setting.

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Centene
Centene
3 months ago

Supervisor, Utilization Management (RN)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 24 days agoStatus: Live

Job Summary

Lead and mentor the Utilization Management team (Prior Authorization, Concurrent Review, and Retrospective Review) to ensure appropriate care for members. Manage day-to-day UM operations, monitor performance and compliance, drive process improvements, and coach staff on policies, guidelines, and regulatory standards within a remote-capable healthcare setting.
Location: California, Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Supervise Prior Authorization, Concurrent Review, and Retrospective Review teams to ensure appropriate care and adherence to guidelines.
  • •Monitor UM resources and team performance to meet quality, compliance, and efficiency standards.
  • •Collaborate with UM team and senior management to identify opportunities for process and quality improvements.
  • •Educate and provide resources to the UM team to facilitate communication with members and providers; ensure guidance on key initiatives.
  • •Onboard, hire, and train UM staff; coach and assess performance; lead change within scope of responsibility.

Pay and Benefits

Salary: USD 75,300 - 135,400 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •RN - Registered Nurse with State Licensure (CA required)
  • •Bachelor's degree or Graduation from an Accredited School Nursing program
  • •4+ years of related experience in utilization management or a healthcare setting
  • •Knowledge of utilization management principles and regulatory/accreditation standards
  • •Ability to supervise and coach a team, onboard/train staff, and drive process improvements
Experience:4+ yearsUtilization managementNursingHealthcare
Education:Bachelor's in Nursing
Skills:CommunicationLeadershipProblem-solving
Licenses:CA RN LICENSE
Certifications:RN
Languages:English
Tech Stack:RNNursing

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