Manager of Regulatory Adherence - El Segundo, United States - Optum

Optum

Verified Company

El Segundo, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

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 liaison between Health Plan delegated entities and Clinical Services Operational teams (UM and CM)
Serves as a liaison between Delegation Oversight and crossfunctional 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

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:

3+ years of Managed Care Experience in Utilization Management and/or Case Management
Experience training or educating clinical and nonclinical staff in a variety of venues and settings
Ability to work PST standard business hours

Preferred Qualifications:

RN or LVN license
Regulatory compliance experience
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, _location_ and incomedeserves 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._

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