***$5,000 Sign-On Bonus for External Candidates***
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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
This position is responsible for utilization management which includes Concurrent Review (on-site or telephonic Inpatient Care Management). Performing reviews of current inpatient services. Determining medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
Referral Management responsibilities and functions include:
Supervises daily management of TAT for Case Management and UM Technician staff in collaboration with the Lead UM Technician
Supervises daily management of the error reports for Case Management and UM Technician staff in collaboration with the Lead UM Technician
Assists with the training, development, and mentoring of new referral management staff
Case Management responsibilities and functions include:
Supervises daily management of acute, SNF, and Rehab admissions for the IPA
Leads team in daily bed day rounds
Provides current census to bed day data collection unit on a daily basis
Assists with the training of new staff on site at local network facilities
Will cover local network facilities in times of staffing shortage or increased census
General responsibilities and functions include:
Participates alongside the UM Manager in completion of performance appraisals
Reviews/presents cases to medical director for referral or bed day denials
Assists the Denial/Appeal Unit in timely manner with all denials and appeals
Attends all pertinent UM Meetings
Other duties as required
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.
Current LVN/RN license in good standing in the state of CA
Associate Degree OR equivalent years (2+ years) of experience in Managed care
2+ years of experience in managed care/IPA or similar experience at a Health Plan or Acute Hospital
1+ years of supervisory experience
Knowledge of Interqual or Milliman guidelines
Full COVID-19 vaccination is an essential requirement of this role, and booster, if eligible. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
Computer knowledge (Excel, Word, Powerpoint)
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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. 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)
**PLEASE NOTE** The Sign-On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a Sign On Bonus.
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.