Supervisor, Utilization Management – RN

Centene Corporation

. Supervise Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team .

Posted 9/24/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $75,300 - $135,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management principles, including Prior Authorization, Concurrent Review, and Retrospective Review, while ensuring compliance with regulations and accreditation standards. Proven ability to lead, coach, and develop a clinical review team to enhance performance and quality of care.

Highest-signal resume keywords

Utilization ManagementClinical Review SupervisionRN - Registered Nurse LicensureCompliance MonitoringPerformance Evaluation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization Management PrinciplesClinical ReviewQuality ImprovementPolicy DevelopmentPerformance Tracking

Soft Skills

Team LeadershipCoachingCollaborationCommunicationProblem-Solving

Certifications & Qualifications

RN - Registered Nurse LicensureCA RN Licensure

Industry Keywords

Accreditation StandardsGuidelines ComplianceHealthcare RegulationsUtilization Management RegulationsClinical Review Policies

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 care member issues
Maintain knowledge of utilization management regulations, accreditation standards, and industry best practices
Identify process and quality improvement opportunities with the utilization management team and senior management
Educate and provide resources to the utilization management team
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

Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience
Knowledge of utilization management principles preferred
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
CA RN Licensure required
Knowledge of utilization management regulations, accreditation standards, and industry best practices
Ability to supervise prior authorization, concurrent review, and/or retrospective clinical review nurses
Ability to ensure compliance with applicable guidelines, policies, and procedures

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
Equal opportunity employer committed to diversity