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.
 

THIS POSITION IS REMOTE/WORK FROM HOME AND QUALIFIED APPLICANTS MUST RESIDE IN THE STATE OF FLORIDA.

Position Purpose: 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 standardsCollaborates with utilization management team to resolve complex care member issuesMaintains knowledge of regulations, accreditation standards, and industry best practices related to utilization managementWorks with utilization management team and senior management to identify opportunities for process and quality improvements within utilization managementEducates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providersMonitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and proceduresWorks with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare servicesEvaluates utilization management team performance and provides feedback regarding performance, goals, and career milestonesProvides coaching and guidance to utilization management team to ensure adherence to quality and performance standardsAssists with onboarding, hiring, and training utilization management team membersLeads and champions change within scope of responsibilityPerforms other duties as assignedComplies with all policies and standards

Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.

License/Certification:rred.

RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $72,400.00 - $130,100.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act