Manager, Utilization Management - Arcadia, United States - Optum

Optum

Verified Company

Arcadia, 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.
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 problemsolving, 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
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

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

Preferred Qualifications:

2+ years of experience in a leadership role
Experience in managed care
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._