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Job Details
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Position in this function is responsible for all activities associated with Utilization Management (UM) programs. Ensures all UM activities are efficient, effective and meet regulatory requirements. Monitors staff performance, provides mentorship and recognizes and manages departmental opportunities that impact outcomes. Primary Responsibilities:
- Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer
- Develops and maintains strong and lasting team member and partner relationships
- Ensure that the team meets performance goals and complies with timeliness, documentation, notification of cases based on LOB requirements
- Exhibits behavior and communication skills that demonstrate commitment to superior patient care, patient experience and patient outcomes
- Proven and effective problem-solving, critical thinking and decision making skills
- Ensures that the regional care management programs meet and exceed compliance adherence; CMS, health plan delegation and quality
- Develops, implements and analyzes data to support best practice outcomes for care management programs
- Meets auditing timeframes and proactively manages gaps and interventions
- Identifies need for and participates in the development and implementation of UM operating procedures
- Identifies and proactively manages staffing efficiencies and productivity, ensuring efficient management of resources
- Collaborates with staff, stakeholders and clinicians to provide a patient centric approach to UM
- Serves as subject matter expert in UM- appropriate use, interpretation of clinical criteria review process such as National Coverage
- Determination, Local Coverage Articles, Local Coverage Determination Health plan Medical Coverage Policies
- Supports and guides staff to be accountable in decision making
- Develops tools and ensures resources are available to support accountable decision making
- Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Performs additional duties as assigned
- Graduate from an accredited school of Nursing
- Current, unrestricted RN or LVN license in California
- 2+ years of experience in utilization management or (prior authorization review) nurse
- 2+ years of experience in a leadership role
- Experience in managed care
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more