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UnitedHealth Group Supervisor Utilization Management - Overland Park, KS in Overland Park, Kansas

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

Responsible for overseeing utilization management processes to ensure patients receive the appropriate level of care and services based on medical needs. Serves as a liaison to providers and patients as needed, as well as a preceptor for less experienced teammates. Works with providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including referrals to case management/social work for patients at high risk for readmission, or who are vulnerable due to health or social determinants. Ensures that patients’ progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Provides medical management as needed to ensure medical necessity and compliance with applicable medical policy and health plan benefits. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. This is performed under the general supervision of the Director of Care Management. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other required training is a condition of employment.

Primary Responsibilities:

  • Oversees an integrated team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review, and/or other utilization management (UM) activities aimed at providing members with the appropriate level of care

  • Functions as a hands-on supervisor, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive UM, ensuring compliance with regulatory and accrediting standards

  • Uses professional judgment, knowledge and departmental guidelines to refer cases to physician advisors

  • Manages and evaluates teammates in the performance of various UM activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new teammates

  • Ensures teammate’s quality audit reviews are completed to include inter-rater reliability (IRR)

  • Performs and promotes interdepartmental integration and collaboration to facilitate the continuity of care including transitions of care

  • Maintains adequate staffing, service levels and customer satisfaction by implementing and monitoring team member productivity and other performance indicators

  • Reports on UM statistics including teammate productivity, cost effective utilization of services, management of targeted member population, referrals to case management and triage activities

  • Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and team member development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines including HIPAA

  • Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement

  • Identifies and addresses opportunities for quality improvement in all aspects of serving our customers. Assists in planning and implementation of systems changes and procedures to achieve overall organizational objectives

  • Maintains effect communication with management regarding development within areas of assigned responsibilities and works on special projects as required

  • Other duties as assigned

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:

  • Associates degree in nursing or LPN with Bachelor’s Degree in related field

  • Active KS and MO LPN or RN License

  • 3+ years of experience in a utilization review function within health plan or integrated system with one (1) year supervisory experience.

  • Working knowledge of HMO’s, PPO’s, Medicare, Medicaid, and insurance plans

  • Knowledge of CPT4/ICD 9 & 10/HCPCS codes

  • PC proficient

  • Ability to travel to offices and facilities for training and meetings (25%)

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Certification in Healthcare Quality (CPHQ) or Case Management (CCM)

  • Ability to counsel and/or consult

  • Ability to communicate and interact professionally with co-workers, management patients, and Providers

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

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.