Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Manager of Clinical Operations for Utilization Management is responsible for the Integrated Care Team, a cross-functional approach, supporting the member end to end, with close collaboration and co-management. The team will manage the full array of health care services, spanning both outpatient and inpatient settings and with support from some specialized clinical teams.

This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, discharge planning, care management and prevention to improve quality of care and patient outcomes. This position will help drive cost effective, quality of care services, for members through daily coordination among UM team members, medical directors, the provider network, UHC leadership, and various other departments. This position is also responsible for overseeing all compliance, productivity, and quality assurance functions for the Integrated Care Team. This position will provide clinical, administrative, and leadership support to clinical and administrative team members in accordance with policies and procedures.

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

Primary Responsibilities: 

• Manages and evaluates direct reports of UM Prior Authorization Nurses, Inpatient Care Managers, Clinical Coordinators, and other team associates
• Manages the compliance for UM to meet established performance metrics
• Oversees inventory and ensures cases completed within regulatory timeframes
• Manages all aspects of the UM program and service timeframes
• Actively participates in process improvement planning and implementation while fostering good communication and collaboration across all teams touching the integrated care team
• Conducts routine audits on UM clinical reviews and NCQA regulations/guidelines
• Develops, implements, reviews, and revises all policies, procedures, workflows, job aids, and other key documents related to UM. Presents to leadership for approval
• Produces routine reports outlining and summarizing key performance indicators
• Organizes and presents at relevant meetings and education session
• Responds to escalated inquiries or complaints from customers, providers, and members and resolves issues appropriately and in a timely manner.
• Exhibits excellent customer service skills
• Interviews, hires, and retains quality clinical and administrative team members to meet the needs of the department
• Applies employee performance management techniques through job-related coaching, training and development activities. Ensures all direct reports remain up to date and in compliance with all education, training, and regulatory requirements. Develops corrective action plans to address gaps as needed
• Exhibits excellent verbal and written communication skills. Provides complete and accurate information in all communications
• Participates in and provides leadership for projects and initiatives as assigned
• Performs all other related 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:

• Bachelor’s Degree in Nursing, Healthcare Administration, Business Administration or related field and/or associate degree in Nursing combined with 2 years of experience above the required years of experience
• Current unrestricted RN Licensure to practice in the applicable state 
• 3 years of related experience in UM process activities such as prior authorization, inpatient review, discharge planning, and/or post-acute care management
• Leadership experience functioning in a Manager, Supervisor, Subject Matter Expert (SME) role
• Medical terminology, ICD-9/ICD-10 and CPT knowledge
• Proficiency with Microsoft Office applications

Preferred Qualifications:

• 2 years practicing as a nurse in an any care setting
• Prior Authorization and Inpatient Care Management experience

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $88,000 to $173,200 annually. 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: UnitedHealth Group 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment