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.

　　THERE ARE 2 POSITIONS AVAILABLE. POSITIONS ARE REMOTE/WORK FROM HOME.

　　THESE POSITIONS SUPPORT AMBETTER MARKET PLACE INSURANCE PROGRAM FOR CENTRAL AND EASTERN TIME ZONES; APPLICANT MUST BE ABLE TO WORK MONDAY - FRIDAY, 8AM - 5PM AND ON-CALL ROTATION ONCE EVERY 5 WEEKS ON THE WEEKEND.

　　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 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

　　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:

　　RN - Registered Nurse - State Licensure and/or Compact State Licensure requiredPay Range: $71,000.00 - $127,500.00 per year

　　Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

　　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.