Supervisor, Utilization Management

Supervisor, Utilization Management – Centene Corporation

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 and a fresh perspective on workplace flexibility.

Position Purpose Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members and oversees day‑to‑day activities of the utilization management team.

• Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards.
• Collaborates with the 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 and senior management to identify opportunities for process and quality improvements.
• Educates and provides resources for the utilization management team on key initiatives and facilitates ongoing communication between the 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 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 the 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.

Graduate of an accredited nursing school or bachelor's degree with 4+ years of related experience. Knowledge of utilization management principles preferred.

Registered Nurse (RN) – State Licensure and/or Compact State Licensure required.

Pay range: $75,300.00 – $ per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office schedules.

Centene is an equal‑opportunity employer committed to diversity. 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 any other protected characteristic. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.

Remote (home-based) within the Central Time Zone.