Supervisor Utilization Management Nurse – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

The Supervisor will directly oversee and develop the Appeals team. S/he will provide direct hands-on guidance and education to Appeals team while ensuring company benchmarks for quality, productivity, and proficiency are achieved and maintained. S/he will work collaboratively with the Manager to ensure that a consistent message is delivered to the Appeals team (onshore and global) and serve as the resource for questions and/or concerns. The Supervisor is responsible for direct oversight of the queues, notification of low queue to Command Center and leadership, and monitoring of staffing. The Supervisor will participate in interdepartmental collaboration to ensure adequate staffing across the business. The Supervisor must be proficient, strategic, drive high quality results, and exhibit solid clinical and communication skills. S/he will lead in the activities of day-to- day business.

The Nurse Supervisor, in collaboration with the Manager, will be responsible for the mentoring and development of staff. S/he will ensure timely completion of reviews, communications, and resolution of concerns/barriers. S/he will provide oversight of the team for early identification of issues that require individualized action plans. S/he will be responsible to ensure resolutions are in place. S/he will participate in internal and external (client) meetings which can include the following: meetings with the revenue cycle team, client/payor huddles, denial discussions, outcomes, processes, and other related topics. The Supervisor will assist in maintaining and updating processes and policies as necessary. The Supervisor will assist the Manager in obtaining, analyzing, and trending reports that will assist in driving business decisions. The Supervisor will participate in client huddles and client meetings as needed and may lead discussion topics. The Supervisor will function as the subject matter expert (SME), identifying trends, highlighting areas to be addressed and assisting to drive changes which will meet client and business expectations. S/he will be responsible for having a thorough knowledge of all appeals types. S/he will be responsible for monitoring QA initiatives and addressing results. S/he will be responsible for monitoring productivity and addressing results. The Supervisor along with the Manager is responsible to ensure OGA teams are included in key meetings, updates, and workflow discussions. S/he will be responsible for daily staffing decisions for all of Appeals and collaborate with leaders of other areas of business on staffing needs. The Supervisor is expected to support OPAS business, understand other lines of business, and provide support and leadership across the department.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Provide monitoring, development, issue validation, and follow-up on items impacting successful workflow to ensure the programs s/he is leading is adding value. This would include, but is not limited to:

• Support and promote OPAS, Optum, and the enterprise goals and mission
• Build relationships across Optum, OPAS, OGA and our clients
• Collaborate with peers in OPAS, LPS, OGA, Product, Medical Management, Case Management, RCM, Compliance, and Quality Management to assure continuity of communication and execution of deliverables as needed
• Support new Product builds, implementation and system testing with internal stakeholders
• Adheres to deadlines and communicates to Leadership when at risk to not meeting expectations
• Participate in and contribute to meetings
• The Supervisor is responsible for direct oversight of the queues including notification of fluctuations to the Command Center and leadership, having an action plan to address and monitoring of staffing
• Performs hourly audits to ensure proper handling of cases to ensure timely and effective turnaround. Will use all monitoring tools to ensure service level expectations are met
• Assist in determining the resources required to complete the volume of cases and ensure all the resources are allocated effectively
• Assistance with case processing as necessary, especially as directed by the Command Center
• Monitor employee time off/schedule compliance with Optum Physician policies while ensuring adequate staffing for business needs
• Monitor schedules/attendance and report in real-time in Verint PTU, no shows, lateness, Call outs, and connectivity issues
• Manage Timecards, PTO
• Supports/educates employees and clients with questions or issues
• Oversees individual team needs, concerns, and issues
• Monitor weekly and monthly reports, addressing issues promptly
• Ensure accuracy in productivity capture
• Monitor onshore and global performance, ensuring pathway to meet expectations
• Mentor employees to identify strengths and weaknesses and provide direction and goals to facilitate individual development
• Provides feedback and identifies areas for improvement and re-education
• Review Cases as needed and provide clinical guidance with follow up as appropriate
• Facilitate meetings and communications with the frontline teams as appropriate
• In conjunction with the Manager, complete yearly team evaluations
• Maintains organization on the team and ensures everyone conducts themselves professionally
• Maintain ongoing consultation with the Manager and Human Resources regarding any potential employee activity, productivity or conduct concerns that may require ongoing discussion and provide appropriate documentation relating to work performance and/or professional conduct which may or does result in disciplinary action
• Effectively resolves any conflicts
• Remains up to date and ensures his/her team are up to date with all Learn Source modules, competencies, and state required licenses
• Provides ongoing analysis of cases completed by the team
• In conjunction with the Manager, monitor quality and productivity of employees, both onshore and global
• Facilitate meetings and communications with other departments to ensure continuity of quality and efficiency (i.e.: Training, Quality, etc.)
• Conducts/ Attends along with the Manager regular meetings with LPS team to ensure clear communication and evaluation on performance
• Conducts/ Attends along with the Manager regular meetings with OGA team, facilitating issue resolution
• Assist in inter-rater reliability and follow up when indicated
• Review Payor documents to help improve outcomes and assist in denial prevention
• Prepare reports with analysis of significant utilization trends and effects/impacts
• Assists with identifying and correcting inaccurate and/or incomplete information
• Assists in the creation of detailed work plans that identify and sequence activities to be completed
• Monitor and evaluate workflows, identifying areas of opportunity for process revision and/or expansion, utilizing the knowledge of all departments to ensure end-to-end evaluation
• Maintain up to date working knowledge of policies/protocols
• Assist in the development of policies, processes, procedures, and technology solutions
• Create, refine and monitor department competencies
• Support the Training and QA team including support of new job aid builds, workflows, and training content evolution
• Assists in the creation of training materials/roadmap, resource guides and job aides for the team to use on the job and for training team members
• Maintains current expertise in MCG application, case reviews, and client management
• Responsible for optimal Employee Engagement
• Participate in the screening, interviewing, and hiring of staff
• Performs other related duties, tasks, and processes as required by the Nursing Manager

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.

Required Qualifications:

• Current and unencumbered Registered Nurse license
• 3+ years bedside nursing experience in ED/Telemetry/ICU/CCU
• Experience working concurrently with multiple tasks and projects, balancing conflicting priorities
• Experience supervising a process/program along with the ability to manage and/or direct change
• Experience prioritizing, successfully managing multiple projects/initiatives
• Solid clinical knowledge base
• Demonstrated analytical skills, deductive reasoning, multitasking and problem-solving abilities and an ability to understand the causes and effects of various drivers impacting workflow processing or workforce activity
• Highly organized and can handle employee concerns/issues in a confidential and professional manner
• Demonstrated leadership skills and characteristics
• Demonstrated analytical skills and an ability to understand the cause and effect of various drivers impacting workflow processing or workforce activity
• Demonstrated collaborative skills and ability to interact with people of different backgrounds and organizational levels, including external clients
• Demonstrated team building, training, and mentoring abilities
• Demonstrated conflict management/resolution
• Demonstrated  solid written and verbal communication skills

Preferred Qualifications:

• Knowledge of the Utilization Review Management
• Proficient in MCG
• High degree of accuracy and proficiency in processing First Level cases or Assigned area

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

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