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.
 

Must reside in the State of Oklahoma!

Now Hiring: Remote Supervisor, Utilization Management

Centene is looking for a dynamic leader to join our team as a Supervisor of Utilization Management for our Oklahoma Medicaid Plan. This remote role is ideal for someone with strong leadership skills and a background in utilization management. Experience in managed care is a plus!

Join us in making a difference—apply today!

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:

RN - Registered Nurse - State Licensure and/or Compact State Licensure required

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.  Total compensation may also include additional forms of incentives.

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 characteristic 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