• Oversees one or more IPA's formal utilization and network coordination services. Provides operational oversight and recommends corrective action for all shared services
• Manages the UM results of one or more of the IPA's, including referral management; acute, SNF and Rehab admissions for the IPA.
• Continually creates and implements strategies to improve IPA and UM Departments performance
• Participates in PrimeCare Medical network, Inc., IPA Utilization Management meetings to enhance communication and continuity of member care services
• Has management responsibility as assigned for the key Medical Management Programs, Coordinated Care Center, DME and Injectable Units
• Participates in determination of department's goals and objectives, setting organizational structure, staffing, and space planning
• Participates in recruitment, retention, and training of NAMM Case Management staff.
• Acts as a resource to other departments in regards to Case Management, Disease Management, and Chronic Care Management.
• Collaborates with appropriate VP of Medical Management, Medical Directors, UM Managers, and other IPA staff as well as other division peers
• Program Development, Implementation and Evaluation
• Conduct needs assessment including: development of methods for determining potential patient enrollment, medical literature review, analysis of pre-program utilization and return on investment
• Development of Program to include establishment of policies and procedures, enrollment strategies, member and physician materials, and measurements of program outcome
• Development of clinical practice guidelines
• Evaluate staff educational needs and coordinate training

• Current, active and unrestricted RN license for the state of California
• High School Diploma or GED required
• 5 or more years of experience with IPA's, Health Plans and Managed Care networks
• 5 or more years of experience as a Case Manager within a managed care environment
• 5 or more years of Management experience within the healthcare industry
• 5 or more years of experience with community based programs (Medicaid, for example)
• Thorough knowledge of regulations and requirements related to utilization management (UM)
• Experience with QA/QI and program development/process improvement
• Ability to travel locally within an 80+ mile radius.
• Employees arerequiredto 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.

• Bachelors (BSN) or Master's degree (MSN)

Careers with Optum.Here's the idea. We built an entire organization around one giant objective; make the health system 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 doyour life's best work.^SM

Diversity creates a healthier atmosphere: 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: RN, nurse, Utilization Management, Case Manager, UM, UR, managed care, Hospital, Ontario, Manager, Director, Care Manager, NAMM, Care Management, NCQA, SNP, Ontario, CA, California