Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

The Supervisor is responsible for supervising the nurses and coordinators by implementing and maintaining an efficient and effective flow of information through the utilization management process. The Supervisor in collaboration with the Manager ensures compliance with all regulatory standards that include state, federal, NCQA, HEDIS, performance improvement, health plan audits and all accreditation criteria. In addition, the Supervisor ensures all medically necessary services are reviewed according to MHC's internal guidelines along with all regulation and delegated standards.

Primary Responsibilities:

• In collaboration with the Manager, the Supervisor recruits, interviews, hires, and effectively on-board new department staff. Supervisors ensure compliance with budgetary requirements. Provide supervision, expert clinical knowledge, and guidance to front line employees
• Identify and provide ongoing educational opportunities to staff, ensuring an understanding of business processes, technology, health care reform and the impact on both the department and the organization
• Develop, implement, and monitor tools that evaluate employee productivity against established benchmark standards and initiate timely corrective interventions as appropriate. Identify opportunities for training and staff development based on achievement of productivity/quality standards
• Adjust workflow responsibilities in line with staff expertise and availability
• Supervisor works to identify and direct staff to document compliant with health plan requirements. Develop, implement, and communicate actions needed to maintain and improve compliance
• Develop, implement, and maintain policy and procedures and standard operating procedures
• Supervisor ensures consistency in application of criteria, development of effective corrective action plans for identified deficiencies, and ensure sound clinical knowledge is applied to guidelines or standard criteria to determine medical necessity of all requests
• 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:

• RN or LVN license, active in good standing
• 5+ years related experience in Utilization Management
• 2+ years supervisory experience
• Demonstrated experience in the areas of: referrals management, health plan audits, utilization review, and NCQA regulatory standards and requirements
• 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
  

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. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

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.