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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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Director, Utilization Management Operations, Registered Nurse, RN, Healthcare, WellMed - San Antonio, TX

UHG - San Antonio, Texas

Posted: 10/16/2018

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 Director, Utilization Management Operations is responsible for planning, organizing, and directing the ancillary support for the Utilization Management team. The Director coordinates team coverage for the Prior Authorization / Hospital Intake team, the Correspondence team and the Medical Claims Review team to ensure compliance with regulatory, contractual and accreditation requirements. The success of this position requires the ability to foster communication and teamwork among physicians, medical management staff, corporate departments, vendors, and senior leadership.


Primary Responsibilities:

  • Monitors Prior Authorization / Hospital Intake call center operations ensuring that the overall performance of the department adheres to corporate and regulatory standards.Oversees departmental functions, workflows, policies and procedures to ensure that all Federal and State regulations and contractual agreements are followed
  • Oversees the implementation of processes and system enhancements which will improve the overall quality and service provided by the UM teams
  • Analyzes trends and identifies/implements departmental initiatives based upon data provided through the reporting of production, quality, financial and audit data
  • Provides input into and supports all applicable employee and other training programs for the department staff to ensure that regulatory compliance requirements are disseminated and understood
  • Oversees the recruiting, performance, development and mentoring of service staff
  • Initiates cross functional/departmental discussions and initiatives to remove barriers and improve communications and work flows
  • Identifies/initiates technology solutions to improve employee productivity and quality
  • Actively participates in the management of the annual departmental budget
  • Actively participates in the development of policies and procedures
  • Performs all other related duties as assigned

This is an office based position located at our office off of Northwest Parkway in San Antonio, TX. The position requires a rotating Saturday shift.

Required Qualifications:

  • Unrestricted Texas RN license with ability to obtain license in other states as necessary
  • Bachelor’s Degree in Nursing, Business Administration, Health Care Administration or related field (Eight additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
  • At least three years of experience at a manager level or above capacity in a call center environment within a managed care organization
  • Knowledge of regulatory and accrediting standards relating to medical management and managed care
  • Knowledge of medical terminology and claims processing
  • Knowledge of fiscal management and human resource management techniques
  • Ability to plan, supervise and review the work of non-clinical staff
  • Requires working under stressful conditions or working irregular hours
  • Creative problem-solving and communication skills
  • Able to work effectively and achieve results in a real time, fast paced environment
  • Analytical skills with strong organization skills
  • Proficiency with Microsoft Office applications to include advanced Excel skills

Preferred Qualifications:

  • Master’s degree
  • 8+ years experience in managed care with a minimum of five years at a management level working in a call center environment

Physical & Mental Requirements:

  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular 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: WellMed, Healthcare, Bilingual, Registered Nurse, RN, Director, Utilization Management, Medicare, CMS, Managed Care, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX

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