RN Supervisor, Appeals, Managed Care, UM

Centene Corporation

RN Supervisor managing utilization management, overseeing clinical teams for Centene's Health Services. Ensuring compliance, quality, and effective healthcare service utilization across member care.

Posted 7/25/2026full-timeRemote • California, New York, Tennessee, Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $75,300 - $135,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management principles, including Prior Authorization, Concurrent Review, and Retrospective Review, while ensuring compliance with regulations and quality standards. Proven ability to lead and develop teams, implement process improvements, and provide education and resources to enhance team performance.

Highest-signal resume keywords

Utilization ManagementRegistered Nurse (RN) LicensureCertified Managed Care Nurse (CMCN)Performance MonitoringTeam Leadership

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization Management PrinciplesPrior AuthorizationConcurrent ReviewRetrospective ReviewQuality ImprovementCompliance StandardsPerformance EvaluationOnboarding and TrainingProcess ImprovementAppeals Process

Soft Skills

CoachingCollaborationCommunicationProblem-SolvingChange Management

Certifications & Qualifications

Registered Nurse (RN) LicensureCertified Managed Care Nurse (CMCN)

Industry Keywords

Managed CareMCOHealthcare ServicesAccreditation StandardsRegulations

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Graduate of an Accredited School Nursing or Bachelor's degree
4+ years of related experience
Strong knowledge of appeals and utilization management principles preferred
3 - 5 years of direct work experience and knowledge of the appeals process and utilization management principles in managed care/MCO environments is preferred
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For Health Net Federal Services: Must have current and active licensure or certification that permits independent assessment required
For Health Net Federal Services (Medical Management): Certified Managed Care Nurse (CMCN) within 1-1/2 Yrs required
For Health Net Federal Services: US citizenship and current National Agency Check government security clearance required

Benefits

Comp & perks

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