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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. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each internal and external customer
- Serves as a subject matter expert to cross-functional staff regarding clinical services regulatory and delegation requirements, and impact to operational processes
- Serves as a subject matter expert regarding Clinical Services Policies and Procedures
- Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (UM and CM)
- Serves as a liaison between Delegation Oversight and cross-functional areas/departments across the organization
- Provides ongoing coaching, mentoring and professional development opportunities to Delegation Oversight staff to deepen their understanding of regulatory and delegation requirements, audit management processes, delegation reporting and Utilization Management and Case Management operational processes
- Serves as a role model for Delegation Oversight staff for relationship management with internal and external stakeholders
- Participates in the documentation effort of department workflow processes to ensure clarity and appropriate training with respect to specific tasks and job requirements
- Participates in educational programs to enhance care management (utilization management and case management) compliance knowledge and ensures staff participation as well
- Manages compliance letter template management process as applicable
- Manages delegation oversight reporting process as applicable
- Manages internal monitoring/auditing process as applicable
- Manages Appeal processing as applicable
- Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Performs additional duties as assigned
- 3+ years of Managed Care Experience in Utilization Management and/or Case Management
- Experience training or educating clinical and non-clinical staff in a variety of venues and settings
- Ability to work PST standard business hours
- RN or LVN license
- Regulatory compliance experience
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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