At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)
The utilization management (UM) manager is responsible for the supervisory oversight and direction of UM department activities to include prior authorization for post-acute services, medical necessity determinations, concurrent and retrospective reviews and discharge planning functions. The UM manager actively participates in management decision making to verify compliance with all contract requirements. This position is based in Indiana.
- Directs the activities of the UM staff, with direct supervision by the medical director and staff geriatrician regarding prior authorization, medical necessity determinations, concurrent review, retrospective review, appropriate utilization of health care services, continuity of care and other clinical and medical management programs
- Coordinates with the SIU manager to make sure service billing and utilization issues are documented and reported to the SIU, and matters requiring SIU review or investigation are timely submitted within five business days to enable recovery of overpayments or other appropriate action
- Aids, approves and intervenes as needed to determine medical necessity, appropriateness and extended length-of-stay decisions
- Assists inpatient care manager in UM of members with complex medical care involving numerous providers or frequent intervention
- Participates in State- or plan-required audits and complies with all reporting requirements by area of responsibility
- Oversees reporting and monitors potential high-cost cases, readmissions, UM statistics to include admits per thousand, bed days per thousand, length-of-stay and readmissions per thousand within 30 days of discharge
- Develops and implements action plans for improvement as needed
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 unrestricted RN license in Indiana
- 5+ years of relevant experience in Utilization Management
- 3+ years in a supervisory role in Utilization Management in a managed care environment
- Experience with LTSS or with MLTSS population
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
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