UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
UnitedHealthcare Health Services division conducts care management activities for the majority of UnitedHealthgroup's commercial and Medicare clients. Clinical Coverage Review is the organization responsible for the initial clinical review of service requests and the clinical review of adverse benefit determinations for UnitedHealth Group.
SUMMARY
Under the direction of the Regional VP Health Services, the Associate Director has oversight to ensure provision of high quality, cost-effective medical services. S/he has 3 primary responsibilities: medical management, program quality and staff retention/development.
Position can be located in our Cypress, CA or San Antonio, TX office. For the right individual we will consider a full time Telecommuter.
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
SPECIFIC RESPONSIBILITIES
- Leads a 130 FTE nursing team for pre-service, prior auth and medical claim review located in CA, TX with telecommuters across multiple regions
- Management over the PacifiCare legacy platform integration
- Collaborates to ensure staff receives appropriate training for new platform
- Ensures compliance with State and Federal regulations, compliance with company policies and procedures while seeking improvement opportunities
Qualifications
Requirements:
- RN with an active license
- Operational management experience over functions like prior auth
- Medicare and/or Commercial Regulatory experience
- Demonstrated successful continuous quality improvement execution.
Assets:
- BSN preferred
- Data and metrics oriented
- Strong leadership competencies
- Demonstrated ability to influence in a large matrixed organization
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
