Supervisor, Appeals

About the role

Centene is seeking a Supervisor, Appeals to lead its Prior Authorization, Concurrent Review, and Retrospective Review clinical teams. This remote position supports 28 million members by ensuring appropriate, high‑quality care through effective utilization management.

Key responsibilities

• Supervise day‑to‑day activities of the utilization management (UM) team, monitoring performance, compliance, quality, and efficiency.
• Collaborate with UM staff to resolve complex member care issues and maintain knowledge of regulations, accreditation standards, and industry best practices.
• Identify and drive process and quality improvements, and develop UM policies, procedures, and guidelines.
• Provide coaching, feedback, and career development guidance to team members.
• Oversee onboarding, hiring, and training of UM personnel.
• Lead change initiatives within the scope of responsibility and ensure adherence to all corporate policies.

Required profile

• Graduate of an accredited nursing school or a Bachelor’s degree with at least 4 years of related experience.
• Strong knowledge of appeals and utilization management principles; 3‑5 years of direct experience in a managed‑care/MCO environment is preferred.
• Active RN licensure (preferably California) and, for Health Net Federal Services, Certified Managed Care Nurse (CMCN) within 1.5 years.
• U.S. citizenship and current National Agency Check security clearance for Health Net Federal Services.

Required skills

What we offer

• Competitive benefits package.
• Flexible workplace options, including remote work.