FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Supervisor, Utilization Management
Centene Corporation. Supervise Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management principles, including Prior Authorization and Concurrent Review, while effectively supervising and developing a clinical review team. Maintains compliance with regulations and accreditation standards, and identifies opportunities for process improvement within a managed care environment.
Highest-signal resume keywords
California RN LicenseUtilization Management PrinciplesCertified Managed Care Nurse (CMCN)Team Supervision and DevelopmentPerformance Monitoring and Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewUtilization ManagementPerformance TrackingQuality ImprovementPolicy DevelopmentOnboarding and TrainingMember Care Issue ResolutionRegulatory ComplianceProcess ImprovementFeedback and Evaluation
Soft Skills
CommunicationCoachingCollaborationLeadershipChange Management
Certifications & Qualifications
Registered Nurse (RN)Certified Managed Care Nurse (CMCN)
Industry Keywords
Managed CareAccreditation StandardsClinical GuidelinesUtilization Management TeamHealth Net Federal ServicesNational Agency CheckAppeals ManagementQuality AssuranceCompliance StandardsHealthcare Regulations
About the role
Key responsibilities & impact- Supervise Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team
- Supervise day-to-day activities of the utilization management team
- Monitor and track UM resources for performance, compliance, quality, and efficiency
- Collaborate with the utilization management team to resolve complex member care issues
- Maintain knowledge of regulations, accreditation standards, and industry best practices related to utilization management
- Identify process and quality improvement opportunities with the utilization management team and senior management
- Educate and provide resources to the utilization management team on key initiatives
- Facilitate ongoing communication between the utilization management team, members, and providers
- Monitor clinical review nurses and ensure compliance with applicable guidelines, policies, and procedures
- Develop and implement UM policies, procedures, and guidelines with senior management
- Evaluate team performance and provide feedback on performance, goals, and career milestones
- Coach and guide the utilization management team
- Assist with onboarding, hiring, and training team members
- Lead and champion change within scope of responsibility
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Current California RN license required
- Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience
- Knowledge of appeals and utilization management principles
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
- For Health Net Federal Services: current and active licensure or certification that permits independent assessment required
- For Health Net Federal Services (Medical Management): Certified Managed Care Nurse (CMCN) within 1-1/2 years required
- For Health Net Federal Services: US citizenship and current National Agency Check government security clearance required
- Must be available Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time
- 3–5 years of direct experience managing appeals and strong understanding of utilization management principles within a managed care environment highly preferred
Benefits
Comp & perks- Health insurance
- 401K
- 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
- Equal opportunity employer committed to diversity