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. Join us and help people live healthier lives while doing your life's best work.(sm)

"The Manager, Delegation Compliance Clinical Services responsible for oversight and management of the processes and staff supporting Optum Clinical Services compliance with regulatory and delegation contractual requirements. Works with the Director of Delegation Compliance Clinical Services to implement and maintain the Clinical Services compliance framework that includes management of delegation oversight and regulatory audits, internal monitoring, corrective action plan development and resolution. The collaborative effort includes but is not limited to partnering with Utilization Management (UM) and Care Management (CM) leadership on process improvement initiatives to support compliance.

"Work Hours: Monday thru Friday (8am to 5pm PST)

"If you are located in PST timezone, you will have the flexibility to work remotely* as you take on some tough challenges

"Primary Responsibilities:

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• Consistently exhibits behavior and communication skills that demonstrate Optums commitment to superior customer service, including quality, care and concern with each internal and external customer
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• Serves as a subject matter expert to cross-functional staff regarding clinical services regulatory and delegation requirements, and impact to operational processes
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• Serves as a subject matter expert regarding Clinical Services Policies and Procedures
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• Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (UM and CM)
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• Serves as a liaison between Delegation Compliance and cross-functional areas/departments across the organization
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• Provides ongoing coaching, mentoring and professional development opportunities to Delegation Compliance staff to deepen their understanding of regulatory and delegation requirements, audit management processes, delegation reporting and Utilization Management and Case Management operational processes
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• Serves as a role model for Delegation Compliance staff for relationship management with internal and external stakeholders
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• Participates in the documentation effort of department workflow processes to ensure clarity and appropriate training with respect to specific tasks and job requirements
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• Participates in educational programs to enhance care management (utilization management and case management) compliance knowledge and ensures staff participation as well
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• Manages compliance letter template management process as applicable
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• Manages delegation oversight reporting process as applicable
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• Manages internal monitoring/auditing process as applicable
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• Manages Appeal processing as applicable
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• Uses, protects, and discloses HCP patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
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• Performs additional duties as assigned
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"Youll 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:

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• Undergraduate degree or equivalent experience
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• RN or LVN with current and active license in state of residence
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• 5+ years of Management experience
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• 3+ years Managed Care Experience in Utilization Management, Case Management and/or Compliance
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• Experience training or educating clinical and non-clinical staff in a variety of venues and settings
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"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. OptumCares support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

"California, Nevada, Washington Residents Only: The salary range for California, Nevada, Washington residents is $85,000 to $167,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.

"*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy

"At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.