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Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Supervisor of Utilization Management oversees and coordinates all clinical and administrative activities for UM Prior Authorization nursing staff in collaboration with the UM Manager and Director of UM. Oversees an effective orientation and comprehensive education program for all new and existing UM staff. Coordinates with all UM leadership and Delegation Oversight to identify required competencies and key performance indicators for the nursing staff and develop training/education programs around identified areas of opportunity.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:

• Exercises a leadership role in the direction, monitoring, and support of the UM Department to meet all regulatory timeframes in collaboration with the UM Manager and Director of UM
• Ensures that all UM functions are staffed appropriately and ensures coverage for sick, vacation absences and holiday coverage; monitors time card accuracy
• Participates in regularly scheduled UM Committee meetings, vendor meetings, department meetings, and health plan audits as required
• Develop specific and measurable competencies and key performance indicators (KPIs) for prior authorization functions and assess all UM staff for deficiencies
• Conduct necessary interventions to improve overall performance of UM staff including identifying opportunities for improvement
• Develop job aides for UM staff that have direct impact on the day-to-day operations and flow of information between departmental business units
• Develop and implement programs as determined by departmental needs, corporate needs, industry standards, and as new regulation/legislation mandates

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 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 including solid knowledge base of health plan and CMS guidelines

Preferred Qualifications:

• Bachelor’s Degree of Science in Nursing, healthcare administration, or other healthcare related field
• 1+ years of experience in a leadership role

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.