1+ months

Supervisor Utilization Management - San Diego, CA - 926341

San Diego, CA 92101
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  • Job Code
    926341

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)

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Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN or LPN/LVN, depending on grade level, with current unrestricted licensure in applicable state. LPN/LVN roles work under the direct supervision of an RN or MD. Function is responsible for utilization management which includes Concurrent Review (on-site or telephonic Inpatient Care Management). Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.

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Primary Responsibilities:

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Referral Management responsibilities and functions include:

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  • Supervises daily management of TAT for Case Management and UM Technician staff in collaboration with the Lead UM Technician.
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  • Supervises daily management of the error reports for Case Management and UM Technician staff in collaboration with the Lead UM Technician.
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  • Assists with the training, development, and mentoring of new referral management staff
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Case Management responsibilities and functions include:

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  • Supervises daily management of acute, SNF, and Rehab admissions for the IPA.
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  • Leads team in daily bed day rounds.
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  • Provides current census to bed day data collection unit on a daily basis
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  • Assists with the training of new staff on site at local network facilities.
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  • Will cover local network facilities in times of staffing shortage or increased census.
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General responsibilities and functions include:

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  • Participates in the UM Manager in completion of performance appraisals
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  • Reviews/presents cases to medical director for referral or bed day denials
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  • Assists the Denial/Appeal Unit in timely manner with all denials and appeals.
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  • Attends all pertinent UM Meetings
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  • Other duties as required
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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.

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Required Qualifications:

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  • Clinical licensure as LVN/RN with an Associate/Bachelors Degree or equivalent years of experience in Managed care
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  • RN or LVN license
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  • 1-2 years supervisory experience
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  • Two (2) to five (5) years managed care/IPA experience
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  • Knowledge of general IPA operations
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  • Previous use of Interqual or Milliman guidelines
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  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role.
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
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Preferred Qualifications:

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  • CCM certification
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  • Team leadership/supervisory skills
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  • Excellent quantitative, organizational and communication skills written and oral
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  • Ability to multitask
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  • Flexible in actions and able to prioritize effectively
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  • Types accurately at 45 wpm
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  • Computer knowledge (Excel, Word, Powerpoint)
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  • Able to problem solve and make decisions independently
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  • Maintains organized files
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  • Knowledge of managed care and UM processes
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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)

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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.

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UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: referrals, coding, quality, medical, terminology, healthcare, utilization management, review, United Health Group, Optum, NAMM, California, CA, San Diego

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Posted: 2021-05-15 Expires: 2021-07-14

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Supervisor Utilization Management - San Diego, CA - 926341

UnitedHealth Group
San Diego, CA 92101

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