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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


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Clinical UM Operations Supervisor - Irvine, CA

UHG - Anaheim, California

Posted: 10/20/2018

At Optum, we share what might be seen as a surprisingly simple goal: making the health system work better for everyone. We look for people who relentlessly push themselves to go farther. For these high performers, a position on a team at Optum, a business of UnitedHealth Group, is a natural fit. We offer more than the talent, resources and can - do culture - we offer a place to improve the lives of others while doing your life’s best work.(sm)
Monarch HealthCare, part of OptumCare, serves the communities within Orange County.
The Clinical Operations Supervisor will be responsible for the day-to-day management of clinical operations within the Utilization Management Department and will be responsible for all UM Coordinator activities.
Primary Responsibilities:

  • Overall supervision of UM Coordinators to ensure efficient workflow and high quality patient care
  • Implement operating policies and procedures, quality assurance plans, and work standards according to Monarch HealthCare, part of OptumCare’s mission, vision, goals, and objectives
  • Maintain compliance with established governmental regulations, health care industry requirements/standards, policies and procedures
  • Develop and implement tools that evaluate employee productivity/quality based on established benchmark standards
  •  Identify opportunities for coaching, training and staff development to achieve productivity/quality standards
  • Initiate, coordinate and monitor the corrective action process, as needed
  • Adjust workflow responsibilities in line with staff expertise and availability and ensure adequate coverage to meet business needs
  • Monitor workflow queues and ensure compliance with regulatory turnaround timeframes (i.e. analyze and send queue inventory report to Medical Directors, Manager, Supervisors)
  • Interview, hire, onboard and train new employees in collaboration with UM RN Supervisor and Manager
  • Address and provide resolution to complaints and escalated issues effectively
  • Participate and support in process improvement initiatives, and LEAN or Six Sigma processes design

Required Qualifications:
  • High School Diploma or GED
  • 3 years of utilization management experience
  • Experience in processing authorizations and preparation of compliant denial letters
  • Proficient in Microsoft Word, Outlook, Excel
Preferred Qualifications:
  • Associates degree
  • Managed care experience
  • Practice Connect Experience
  • 1+ years of managerial/supervisory experience

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.SM


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.


Job Keywords: Supervisor, UM, authorizations, appeals, workflow, denials, managed care, practice connect, manager, AA, Irvine, Santa Ana, Garden Grove, CA

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