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The Manager Utilization Management is responsible for clinical operations and medical management activities across the continuum of care, utilization management, and medical management consulting. The Manager of Medical Utilization Management will oversee utilization management staff and processes for utilization management for acute inpatient and observation visits, prior authorizations, and all other UM activities using Milliman care guidelines.

Primary Responsibilities:

• Ensures staff are motivated to function as a team and trained in Optum KC processes to assure consistency and accuracy and provide the highest quality of service to the patients
• Coordinates, supervises, and is accountable for the daily activities of business support, technical or production team or unit
• Communicate with stakeholders, appropriate healthcare-related information to ensure timely coordination of care and services for patients
• Utilizes approved clinical criteria to assess and determine the appropriate level of care for patients currently receiving care
• Acts as a project coordinator for new medical management processes to improve the care of the patients as required
• Demonstrate initiative toward problem-solving without direct supervision
• Integrate guidelines tools/ to negotiate the most effective plan of care
• Formulates plans that incorporate the health plan
  

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:

• Bachelor’s degree
• Active unrestricted MO/KS RN license or Compact License accepted to start
• 2+ years of varied clinical experience in a hospital setting, emphasizing case management or utilization management
• Knowledge of utilization management in a managed care environment
• Knowledge of Interqual or Milliman guidelines and CMS guidelines
• Understand the spectrum of the alternate delivery system
• Organizational and computer skills
• Written and oral communication skills
• Good problem-solving skills
• Assess patient needs to coordinate the appropriate level of care - ability to negotiate with professionals, patients, and caregivers
• Independent case management knowledge and skills to formulate care plans without direct supervision
• Ability to contribute to the organization’s efforts to eliminate racial and ethnic disparities in organizational performance
• 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:

• Master’s degree
• Experience in a managed care organization
  

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 at OptumCare . We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place 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.