Utilization Management - UM RN Supervisor - New Mexico (Telecommute)

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Optum Medical Network is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network's focus is to do the right things for patients, physicians, and the community. Optum Medical Network's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of Optum Medical Network is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care.

The Utilization Management (UM) RN Supervisor supports the UMRN team by providing leadership and overseeing the day - to - day operations. And assisting with program development to ensure the objectives of the program are met.

If you are located within the state of Arizona OR New Mexico, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Provides clinical guidance and support to assigned UM RNs and other staff
  • Assists in the hiring, orientation, training, and retention of UMRNs and other staff Performs oversight of UMRN caseloads and makes adjustments as needed for effective utilization management
  • Assists in process improvement efforts
  • Regularly audits or oversees the audits of the UMRN team's documentation on patient assessments
  • Support to Medical Directors, providing expertise in the review of complex cases
  • Accountable for defined outcomes and metrics associated with the utilization management processes
  • Serves as the clinical liaison and collaborates with acute and extended care facilities
  • Provide expertise for clinical authorizations including Outpatient Observation, Inpatient, and SNF based on MCG guidelines
  • Perform concurrent review to identify members / beneficiaries with lengths of stay longer than predicted model and identify any barriers to discharge
  • Collaborate with facility staff in transition of care of members / beneficiaries
  • Facilitate the use of community resources to mitigate return to acute of our members / beneficiaries
  • Identify appropriate high-risk members / beneficiaries through a variety of tools and resources
  • Coordinating UM rounds and other projects
  • Ensures standardized execution of workflow processes, policy and procedure, auditing, etc.
  • Manages UM RN assigned case load
  • Confers with Medical Directors on a regular basis regarding cases and workflows
  • Advocating and facilitating members / beneficiaries with transitions of care issues, as needed
  • Other assigned duties

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:
  • Current, unrestricted RN license in the state of AZ/NM
  • Bachelor's degree in nursing (BSN)
  • MCG certification, if does not have certification, must obtain within 2 years of hire
  • 3+ years of experience in an acute care setting
  • 1+ years of leadership experience
  • Experience using EMR, utilization management and / or prior authorizations systems
  • Knowledge of utilization management, quality improvement, discharge planning with transitions of care
  • Experience with Microsoft Office

Preferred Qualifications:
  • Experience working with Medicare members
  • MCG utilization management experience
  • Working knowledge of hospice and palliative care
  • Graduate degree in related field
  • Working knowledge of Acute Rehab, SNF & LTACH facilities
  • Possess planning, organization, conflict resolution, negotiating and interpersonal skills
  • Independent problem identification / resolution and decision-making skills
  • Able to prioritize, plan, and handle multiple tasks / demands simultaneously

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)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

Job Keywords: Utilization Management, UM RN Supervisor, Phoenix, AZ, Arizona, NM, New Mexico , Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote