Utilization Management Supervisor - Remote in MST

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.

Optum Medical Network is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network's focus is to do the right things for patients, physicians, and the community. Optum Medical Network's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of Optum Medical Network is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

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.

The Utilization Management (UM) RN Supervisor supports the UMRN team by providing leadership and overseeing the day - to - day operations and assisting with program development to ensure the objectives of the program are met.

If you reside in Mountain time zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Provides clinical guidance and support to assigned UMRNs and other staff
• Assists in the hiring, orientation, training, and retention of UMRNs and other staff Performs oversight of UMRN caseloads and makes adjustments as needed for effective utilization
• Assists in process improvement efforts for OptumCare
• Regularly audits or oversees the audits of the UMRN team's documentation on patient assessments
• Support to all OptumCare Medical Directors, providing expertise in the review of complex cases
• Accountable for defined outcomes and metrics associated with the utilization management processes
• Serves as the clinical liaison and collaborates with OptumCare facilities
• Provide expertise for clinical authorizations including Outpatient Observation, Inpatient, and MCG guidelines
• Perform concurrent review to identify members / beneficiaries with lengths of stay longer than predicted model and identify any barriers to discharge
• Collaborate with facility staff in transition of care of members / beneficiaries
• Facilitate the use of community resources to mitigate return to acute of our members / beneficiaries
• Identify appropriate high-risk members / beneficiaries through a variety of tools and resources
• Coordinating UM rounds and other projects
• Ensures standardized execution of workflow processes, policy and procedure, auditing, etc.
• Manages UMRN assigned case load
• Confers with Medical Directors on a regular basis regarding OptumCare facilities and cases
• Advocating and facilitating members / beneficiaries with transitions of care issues, as needed
• Other assigned duties

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:

• Bachelor's degree in nursing (BSN) or equivalent experience
• Current, unrestricted RN license in a compact state
• 3+ years of experience in an acute care setting
• 1+ years of leadership experience
• Experience using EMR, utilization management and / or prior authorizations systems
• Experience with Microsoft Office
• Knowledge of utilization management, quality improvement, discharge planning with transitions of care

Preferred Qualifications:

• Graduate degree in related field
• MCG certification, if does not have certification, must obtain within 2 years of hire
• Experience working with Medicare members
• MCG utilization management experience
• Working knowledge of hospice and palliative care
• Working knowledge of Acute Rehab, SNF & LTAC facilities
• Possess planning, organization, conflict resolution, negotiating and interpersonal skills
• Independent problem identification / resolution and decision-making skills
• Able to prioritize, plan, and handle multiple tasks / demands simultaneously

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 al 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.