Supervisor, Appeals

Imagine a role where your leadership directly impacts the health journeys of 28 million individuals. At Centene, we are constantly seeking dedicated clinical professionals who are ready to make a significant difference. We value diverse perspectives and offer competitive benefits, including real flexibility in your workday. This is your chance to lead a vital team, ensuring our members receive nothing but the highest quality care. We’re looking for a passionate Supervisor, Appeals to join our Medical Management/Health Services team, working entirely remotely from anywhere in the world. While we welcome applications globally, please note that a current and active Registered Nurse (RN) license from the state of California is strongly preferred for this particular role.

Overview

As a key member of our Medical Management/Health Services team, you will empower and guide a dedicated clinical review team. Your work directly contributes to ensuring appropriate care for our extensive member base by overseeing the critical functions of utilization management. This remote position offers the unique opportunity to contribute to a national organization committed to improving health outcomes across the globe.

Key Responsibilities

As our Supervisor, Appeals, you'll be at the heart of our utilization management efforts. Your main focus will involve guiding and empowering a clinical review team. This team handles critical functions such as:

Supervising prior authorization, concurrent review, and retrospective review processes.
Diligently monitoring and tracking utilization management resources, ensuring adherence to performance, compliance, quality, and efficiency standards.
Collaborating closely with the utilization management team to navigate and resolve complex care issues for members.
Continuously maintaining expertise on all relevant regulations, accreditation standards, and industry best practices related to utilization management.
Working hand-in-hand with both your team and senior management to pinpoint opportunities for refining processes and elevating the quality of our utilization management.
Educating and providing essential resources to your utilization management team, fostering their continuous professional growth.

Requirements

To thrive in this role, you should possess:

A current and active Registered Nurse (RN) license. A current and active RN license from the state of California is strongly preferred.
Demonstrated experience leading or supervising a clinical review team within utilization management.
Excellent communication and interpersonal skills, with the ability to inspire and guide a remote team effectively.
A deep understanding of healthcare regulations, accreditation standards, and a steadfast commitment to quality member care.

What You'll Gain

Joining Centene means more than just a job; it’s an opportunity to shape healthcare for millions. You’ll be part of a diversified, national organization known for its forward-thinking approach to workplace flexibility and comprehensive benefits. You will gain invaluable experience in a leadership role, directly influencing care standards and operational excellence. This position offers a pathway for significant professional growth, allowing you to contribute meaningfully to a mission that genuinely changes lives.