Centene Corporation is a Fortune 500, mission-driven healthcare leader committed to transforming the health of the communities we service, one person at a time.
Supervisor, Utilization Management
Location
Missouri
Posted
4 days ago
Salary
$75.3K - $135.4K / year
Seniority
Senior
Job Description
Supervisor, Utilization Management
Centene Corporation
• Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to NICU members • 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
Job Requirements
- Graduate of an Accredited School Nursing or Bachelor's degree
- 4+ years of related experience
- Knowledge of utilization management principles preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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