12 days old

Utilization Management (UM) RN Supervisor

Phoenix, AZ 85003
  • Job Code
    894598

Optum Medical Network is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network's focus is to do the right things for patients, physicians, and the community. Optum Medical Network's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of Optum Medical Network is on seniors, and those with complex care needs, who most benefit from a high touch model of care.  


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 Utilization Management (UM) RN Supervisor supports the UMRN team by providing leadership and overseeing the day - to - day operations. And assisting with program development to ensure the objectives of the program are met.  


Primary Responsibilities:

  • Provides clinical guidance and support to assigned UMRNs and other staff
  • Assists in the hiring, orientation, training, and retention of UMRNs and other staff Performs oversight of UMRN caseloads and makes adjustments as needed for effective utilization
  • Assists in process improvement efforts for OptumCare AZ
  • Regularly audits or oversees the audits of the UMRN team's documentation on patient assessments
  • Support to all OptumCare AZ Medical Directors, providing expertise in the review of complex cases
  • Accountable for defined outcomes and metrics associated with the utilization management processes
  • Serves as the clinical liaison and collaborates with OptumCare AZ facilities
  • Provide expertise for clinical authorizations including Outpatient Observation, Inpatient, and SNF based on MCG guidelines
  • Perform concurrent review to identify members / beneficiaries with lengths of stay longer than predicted model and identify any barriers to discharge
  • Collaborate with facility staff in transition of care of members / beneficiaries
  • Facilitate the use of community resources to mitigate return to acute of our members / beneficiaries
  • Identify appropriate high risk members / beneficiaries through a variety of tools and resources
  • Coordinating UM rounds and other projects
  • Ensures standardized execution of workflow processes, policy and procedure, auditing, etc.
  • Manages UMRN assigned case load
  • Confers with Medical Directors on a regular basis regarding OptumCare AZ facilities and cases
  • Advocating and facilitating members / beneficiaries with transitions of care issues, as needed
  • Other assigned duties

 

 

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.

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Posted: 2020-10-08 Expires: 2020-11-07

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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Utilization Management (UM) RN Supervisor

UnitedHealth Group
Phoenix, AZ 85003

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