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Centene Corporation · 4 hours ago

Supervisor, Utilization Management

Wisconsin, United States

Full-time

Hybrid

Mid, Senior Level

$75K/yr - $135K/yr

4+ years exp

Centene Corporation is a diversified, national organization seeking a Supervisor for their Medical Management/Health Services team. The role involves supervising the Prior Authorization Nurses and ensuring appropriate care to members while monitoring compliance and quality standards.

Hospital & Health Care

Responsibilities

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