What are the responsibilities and job description for the Supervisor, Utilization Management position at Centene Corporation?
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.
- 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
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Knowledge of utilization management principles preferred.
License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
Salary : $71,500 - $90,600