Centene Corporation

Compensation

Full Description

Job Description: • Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team • Ensures appropriate care to members • Manages utilization management issues related to member care, provider interactions • Facilitates operations within utilization management • Develops, implements, and maintains compliance with utilization management policies and procedures • Reviews utilization management reports to identify trends and areas of improvement • Educates and provides resources for utilization management team on key initiatives • Collaborates with the senior management team to develop and implement UM policies, procedures, and guidelines • Provides coaching and guidance to utilization management team • Assists utilization management senior leadership with onboarding, hiring, and training utilization management team members Requirements: • Graduate of an Accredited School of Nursing or Bachelor's degree • 5+ years of related experience • 2+ years supervisory experience preferred • Knowledge of utilization management principles preferred • Applicants must possess NY RN State Licensure Benefits: • competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules