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. Work Schedule & Requirements Fully remote position operating on an Eastern Standard Time (EST) schedule, Monday through Friday, 8:30AM – 5:00PM. Active New York State Registered Nurse (NYSRN) licensure required at the time of application. 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. Responsibilities 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 ongoing 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 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. Education & Experience Graduation from an accredited school of nursing or bachelor’s degree. At least 4years of related experience. Knowledge of utilization management principles preferred. License / Certification Registered Nurse (RN) – State licensure and/or Compact State licensure required. Active New York State Registered Nurse (NYSRN) licensure required at the time of application. Pay Range $75,300.00 – $135,400.00 per year. 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. Benefits Competitive pay. Health insurance. 401(k) and stock purchase plans. Tuition reimbursement. Paid time off plus holidays. Flexible approach to work with remote, hybrid, field or office work schedules. Equal Opportunity Employer Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristics protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act. #J-18808-Ljbffr Centene Management Company LLC