Consistently exhibits behavior and communication skills that demonstrate Optums commitment to superior customer service, including quality, care and concern with each internal and external customer Serves as a subject matter expert to cross-functional staff regarding clinical services regulatory and delegation requirements, and impact to operational processes Serves as a subject matter expert regarding Clinical Services Policies and Procedures Serves as a liaison between Health Plan delegated en... more details
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.
Youll 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 Optums commitment to superior customer service, including quality, care and concern with each internal and external customer
- Serves as a subject matter expert to cross-functional staff regarding clinical services regulatory and delegation requirements, and impact to operational processes
- Serves as a subject matter expert regarding Clinical Services Policies and Procedures
- 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 cross-functional 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
Youll 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 non-clinical 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 Groups 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, youll 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 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.