Supervisor, Credentialing/UM (Hybrid in San Diego)

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 to start Caring. Connecting. Growing together.

The Supervisor, Credentialing/UM is a dual-function leadership role responsible for overseeing both provider credentialing operations and utilization management (UM) processes. This position ensures compliance with regulatory standards, supports efficient workflows, and provides mentorship and oversight to staff handling prior authorizations, provider records, and credentialing documentation

Primary Responsibilities: This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its’ employees will need to assume other “non-essential functions” not listed herein which support company business objectives. This may include duties that fall outside of the normal position scope.

• Supervision & Team Leadership
• Lead and manage a team of Credentialing Coordinators and UM 
  Representatives
• Assign tasks, monitor performance, and provide coaching and mentorship
• Develop and implement best practices across credentialing and UM 
  workflows
• Facilitate training and support for new hires and ongoing staff development
• Utilization Management Operations
• Oversee daily processing of prior authorization requests to meet turnaround time standards
• Coordinate with health plans for benefit interpretation and policy 
  clarification
• Support clinical staff by facilitating communication with physician offices and managing referrals
• Ensure accurate data entry and document distribution (e.g., fax sorting)
• Serve as escalation point for complex service requests and member/provider inquiries
• Credentialing & Compliance
• Manage credentialing and re-credentialing of healthcare providers in 
  accordance with NCQA, CMS, and health plan standards
• Maintain accurate provider records and credentialing databases
• Lead compliance efforts, including reporting and adherence to state and federal regulations
• Conduct audits and quality checks, including annual NCQA integrity audit analysis
• Collaboration & Reporting
• Act as primary contact for credentialing and UM inquiries from internal teams, providers, and external agencies
• Collaborate with health plans and internal departments to ensure seamless operations
• Prepare and present reports on credentialing status, UM metrics, and compliance outcomes

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:

• High School Diploma/GED (or higher)
• 1+ years of experience in healthcare operations, including credentialing and utilization management
• 1+ years in a supervisory role
• Experience in a managed care or healthcare setting
• Experience with prior authorization processes and compliance audits
• Proficiency in medical terminology, credentialing software, and Microsoft Office

• Proven solid leadership, organizational, and problem-solving skills

   

• Proven to utilize solid verbal and written communication skills

Preferred Qualification:

• Certification as CPCS or CPMSM
•  ICD/CPT coding
• Supervisory experience in a managed care setting

ADDITIONAL POSITION EVAULATION FACTORS:

• Impact of Decisions: Support of company’s goals and strategies to provide high quality service utilizing a cost-effective approach for our customers and employees.
• Internal/External Contacts: Internally interacts with all levels of the organization. Externally interacts with physicians, physician’s office staff, health plan employees, ancillary providers, hospital personnel, members and their family.
• Supervision Given/Received: Provides general supervision to exempt staff and direct supervision to non-exempt staff. Receives limited supervision from Manager, Utilization Management. Exercises discretion and independent judgement on matters of significance to the organization.

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 $48,700 to $87,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

OptumCare 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.

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