Supervisor, Utilization Management – Remote

Optum CA is seeking a Supervisor, Utilization Management to join our team in Irvine, CA. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Supervisor of Utilization Management oversees and coordinates all clinical and administrative activities for UM Prior Authorization staff in collaboration with the UM Manager and Director of UM. Oversees an effective orientation and comprehensive education program for all new and existing UM staff. Coordinates with all UM leadership and Delegation Oversight to identify required competencies and key performance indicators for the nursing staff and develop training/education programs around identified areas of opportunity.

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

Primary Responsibilities: 

• Exercises a leadership role in the direction, monitoring, and support of the UM Department in collaboration with the UM Manager and Director of UM
• Ensures that all UM functions are staffed appropriately and ensures coverage for sick and vacation absences; monitors time card accuracy
• Participates in regularly scheduled UM Committee meetings, JOC’s with health plans and vendors, department meetings, health plan audits, and interdepartmental meetings as required
• Develop specific and measurable competencies and key performance indicators (KPIs) for prior authorization functions and assess all UM staff for deficiencies
• Conduct necessary interventions to improve overall performance of UM staff
• Develop job aides for UM staff that have direct impact on the day-to-day operations and flow of information between departmental business units
• Develop and implement programs as determined by departmental needs, corporate needs, industry standards, and as new regulation/legislation mandates

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
• 1 + years of experience in managed care

  
Preferred Qualifications:         

• Bachelor’s Degree in healthcare administration or other healthcare related field
• 1+ years of experience in a leadership role

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C.  Residents Only: The salary range for this role is $70,200 to $137,800 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.

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