RN Manager, Clinical Operations Oversight

Centene Corporation

. Lead implementation and staffing oversight for audits of Utilization Management and Care Management Appeals activities .

Posted 10/28/2026full-timeRemote • Florida • United StatesMid-LevelSenior💰 $87,700 - $157,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in regulatory compliance, audit management, and operational oversight within healthcare settings, ensuring adherence to NCQA standards and effective leadership in team development and performance management.

Highest-signal resume keywords

Regulatory ComplianceAudit ManagementLeadership ExperienceHealthcare DeliveryNCQA Standards

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementCare ManagementAudit ProgramsPerformance Quality AuditsOperational Process ComplianceBusiness Monitoring AuditsCorrective Action PlansFile Risk AssessmentsSurveillance ReportsEducation Opportunities

Soft Skills

LeadershipMentorshipCommunicationCollaborationPerformance Management

Certifications & Qualifications

Bachelor's Degree in Health CareClinical Licensure (RN)LWCS/MSW LMHC Licensure

Industry Keywords

HealthcareComplianceAccrediting Agency RequirementsState and Federal GuidelinesEQRO AuditsCMS Audits

About the role

Key responsibilities & impact

Lead implementation and staffing oversight for audits of Utilization Management and Care Management Appeals activities
Provide guidance and oversight to Utilization Management, Care Management and/or Appeals leadership and Compliance Officers regarding accrediting and regulatory agency requirements
Oversee daily operations management and associate development for compliance monitoring
Manage business monitoring audits, staff performance quality audits, surveillance and defect reports
Provide systemic reports and education opportunities to executive leadership, departmental leaders and associates
Partner with senior leadership to identify and implement business expansion opportunities
Ensure operational processes comply with NCQA standards and state and federal contract guidelines
Coordinate monthly and quarterly audit and business monitoring results, highlighting improvement opportunities
Coordinate with Training to ensure curriculum supports operational processes
Implement audit programs for operational-process compliance
Report audit results to management and market leadership
Support departmental responses to EQRO/State and CMS audits
Oversee file risk assessments for external audits
Provide leadership feedback on audit results, improvement opportunities and Corrective Action Plans
Lead Monitoring Teams conducting research, education and audits
Provide Compliance team performance reports to leadership
Perform special projects and other assigned duties
Comply with all policies and standards

Requirements

What you’ll need

Bachelor's Degree in Health Care related field, or related work experience required
5+ years of regulatory, audit, oversight or healthcare delivery required
Previous leadership, senior mentorship experience including responsibilities for hiring, training, assigning work and managing performance of staff required
Clinical licensure (RN) if managing team with RNs
LWCS/MSW LMHC licensure if leading team of Behavioral Health Professionals
Compliance with NCQA standards and state and federal contract guidelines
Full-time or part-time status and other job-related factors may affect pay

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation