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 Manager reports to the UM Director and is responsible for the leadership of a virtual team of Nurse. We strive to provide our members with the most appropriate care, at the most appropriate time during their period of illness or injury.
Oversees the Inpatient case management area
Manage a team size of approximately 15 - 20 nurses
Responsible for metrics of team and productivity reporting
Responsible for auditing of nurses to monitor that clinical criteria guidelines are being followed
Daily/weekly multidisciplinary case rounds
Required to created innovative approaches to meeting metrics
Responsible for participating in workgroups and initiatives
Support and drives change management for all initiative
Responsible for auditing and staff development, training, performance management and all hiring/ onboarding processes
Troubleshoot and investigate claims and authorization issues as needed
Participation in Regional/national committee meetings
Occasional local/national travel
Work queues management
Daily census management
Registered Nurse (RN), current and unrestricted license
Experienced with medical necessity guidelines including MCG guidelines and/or InterQual guidelines
Experienced in Medicaid, Medicare and/or Commercial lines of business
Understanding utilization review process including census management
3 or more years of acute RN experience post licensure
Discharge planning experience
Proficient computer skills to include Microsoft Office (EXCEL. WORD, POWERPOINT), email, Internet and clinical programs
3 or more years supervisory/leadership experience
3 or more years of Managed Care experience
Strong knowledge NY Medicaid
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Utilization Management, Inpatient Care, MCG; RN; Supervisor; NY; Medicaid; BSN
Unitedhealth Group Inc.