At UnitedHealth Group, you'll improve the health of others while you help us heal the entire health care system. As a Utilization Management Supervisor, you will make sure our health services are administered efficiently and effectively. You will direct the activities of the clinical team who evaluates the appropriateness and efficiency of the use of medical services, procedures and facilities. This is an inspiring job at a truly inspired organization. Ready make an impact? Join us today. Primary Responsibilities:Manages clinical review process of all acute and sub-acute and out patient services for appropriateness based on medical criteria Creates accountability and outcome measures for clinical team including clinical and financial goals Participates with executive leadership to ensure authorization standards are current and makes changes as needed Ensures state regulatory and NCQA accreditation standards are met Interfaces with TPA and Clinical documentation support team to establish and assure practice meets standards Directs member advocacy activity and encourages staff to seek and coordinate creative solutions to support members access to clinical services based on medical necessity without compromising quality outcomes Develops change management strategy for utilization activities Mentors, leads and directs staff including day-to-day supervision, schedule, employee relations and staff developmentThis position will work in the Falls Church, VA office with the ability to telecommute 1-2 days per week following an orientation period and manager approval.
Required Qualifications:Current, unrestricted RN license in the state of VA or the ability to obtain upon hire 3+ years of clinical experience in utilization management Supervisory or leadership experience Experience working with Microsoft Windows and the ability to toggle between various systems Familiarity with Milliman criteria guidelinesPreferred Qualifications:Case management certification and/or experience Experience with utilization management in a health plan Experience in discharge planning and/or chart review Familiarity with ASAM criteria Experience working with TrizettoCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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. Job Keywords: Registered Nurse, Nurse, RN, INTotal2017, Utilization, Prior Authorization, UR, Utilization Management, UM, Case Management, Case Manager, Quality, Quality Improvement, Health Care, Medicaid, Medicare, Managed Care, Milliman, Regulatory Compliance, Supervisor, Manager, CMS, Clinical, Falls Church, Virginia, VA, UHC, UnitedHealthcare, Community and State, Public Sector
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.