Friday , September 29 2023

Uhc Careers – Utilization Manager

Website United HealthCare

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

Apply Here