Uhc Careers – Utilization Manager

Job Description:

The Minnesota LTSS Utilization Management Manager will be responsible for creating a utilization management program that supports our care coordination team in determining appropriate service level authorizations for waivered home-based case services (HBCS). After implementation, the manager will have program management, audit and oversight duties related to day-to-day operations, policies & procedures and quality alignment to ensure utilization management and case management functions are streamlined and effective. to staff that supports care of members by completing face-to-face or telephonic health assessments focusing on complex care management and keeping members healthy and independent. There is a strong focus on addressing racial disparities, delivering person-centered care, collaboration with the county and community organizations and creating innovation and value within our programs. This position will not have any direct reports.

Job Responsibilities:

• Engage in collaborations with case management and coordination of care, supporting Service Coordinator team members in the field
• Support clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
• Oversight of medical necessity determinations for LTSS Long Term Support and Services
• Plans, organizes, and oversees staff to ensure timely completion of assessments
• Adapts departmental plans and priorities to address business and operational challenges
• Ensures team meets established performance metrics and performance guarantees
• Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
• Takes lead role in setting direction and participating in developing new programs
• Other duties as assigned to support team
• Sets team direction, resolves problems and provides guidance to members of the team
• Oversees the department’s daily staffing requirements to meet program standards

Job Requirements:

• Intermediate skills with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
• Full COVID-19 vaccination is an essential job function of this role.
• Current, unrestricted RN license in the State of Minnesota

Qualification & Experience:

• Case Management experience
• Medicare and / or Medicaid experience
• 1+ Utilization Management experience
• BSN
• 1+ years of experience addressing health inequities within a health plan, clinical practice or in a community setting
• 1+ years of experience working with members who are enrolled in a Minnesota Health Care Program (MSHO, MSC+, SNBC)
• Experience / exposure with discharge planning
• 2+ years of RN experience of in a hospital setting, acute care, direct care case management, home health care or clinical experience in acute / rehab / or long – term care setting

Job Details:

Company: United HealthCare

Vacancy Type: Full Time

Job Location: Minnetonka, MN, US

Application Deadline: N/A

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