OptumCare Utilization Management RN Supervisor Job Opening

OptumCare Utilization Management RN Supervisor

UnitedHealth Group

• West Valley City, Utah
Category: Nurse
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. Join us and help people live healthier lives while doing your life's best work.(sm)
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.
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 UT
  • Regularly audits or oversees the audits of the UMRN team’s documentation on patient assessments
  • Support to all OptumCare UT 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 UT facilities
  • Provide expertise for clinical authorizations including Outpatient Observation, Inpatient, and SNF based on 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 / eneficiaries 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 UT facilities and cases
  • Advocating and facilitating members / beneficiaries with transitions of care issues, as needed
  • Other assigned duties


Required Qualifications:
  • Current, unrestricted RN license in the state of UT
  • Bachelor’s degree in nursing (BSN)
  • 1+ years of leadership experience
  • 3+ years of experience in an acute care setting
  • Experience using EMR, utilization management and / or prior authorization systems
  • Knowledge of utilization management, quality improvement, discharge planning with transitions of care
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
  • MCG certification, if does not have certification, must obtain within 1 year of hire
  • Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area
Preferred Qualifications:
  • Experience working with Medicare members
  • MCG utilization management experience
  • Working knowledge of hospice and palliative care
  • Graduate degree in related field
  • Working knowledge of SNF & LTAC facilities
  • Independent problem identification / resolution and decision making skills
  • Able to prioritize, plan, and handle multiple tasks / demands simultaneously
  • Experience with Microsoft Office

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical
practices or any of their physicians.


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.