UHG

About UHG

Careers at UnitedHealth Group

 

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

 

Job Category:

Nurse

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

Registered Nurse, RN, Supervisor, Case Management Services, Healthcare, WellMed - San Antonio, TX

UHG - San Antonio, Texas

Posted: 11/17/2018

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 Supervisor of Utilization Management Services is responsible for the supervision, evaluation and direction of the Utilization Compliance and Quality Management process. The position will ensure compliance with the utilization management program for all pre service requests and empowers team members through active problem solving and resource direction. The position is a resource for difficult or complex and/or exceptional preauthorization requests. The supervisor successfully impacts assigned team and organization by mentoring those who wish advancement and engages in departmental process improvement teams and activities. In addition, the Utilization Management Supervisor is responsible for timely completion of documentation audits, and reviewing and mentoring team members to meet and exceed all documentation compliance standards. This position mentors and trains staff in the completion of timely, accurate um determinations and functions as an advisor to Physicians and lower level utilization management staff.

 

Primary Responsibilities:

  • Assist in development of training materials; acts as Subject Matter Expert
  • Fields questions and serves as a resource for Clinicians and non-clinicians Assists with reviews and updates job aids to maximize quality and productivity
  • Trend, analyze and improve processes and suggests improvements
  • Supports utilization management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
  • Oversees utilization management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements
  • Plans, organizes and oversees staff to ensure timely completion of um determinations
  • Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly metric reports
  • Adapts and collaborates with management on departmental plans and priorities to address business and operational challenges
  • Oversees the team’s daily staffing requirements to meet program standards
  • Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
  • Analyze, communicate results/trends, and collaborate with leaders to develop action plans for key reports: TAT Report, Quality audits and any other additional team specific reports
  • Tracks and trends outcomes for potential improvements in the utilization management process
  • Interviews, hires, and retains staff in collaboration with management to meet the needs of the department
  • Evaluates staff performance and conducts merit increases, and disciplinary actions on staff as needed
  • Conducts annual evaluations of team members in a timely basis; provides feedback in a constructive manner and respects the confidentiality of personnel issues
  • Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
  • Monitors appropriate utilization of resources, overtime, and supplies
  • Reviews difficult and/or exceptional preauthorization requests while assisting with any escalated issues from providers
  • 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:

  • Current unrestricted RN license in the applicable state
  • 5+ years of healthcare experience to include experience in a managed care setting, hospital setting and/or physician practice setting, or similar experience
  • 1+ years of demonstrated supervisory or management experience with responsibility for team performance management
  • Solid experience with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
  • Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public

Preferred Qualifications:

  • Bachelor of Science in Nursing (BSN) or (Four additional years of experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
  • Data mining, analytical and reporting skills with the ability to review and interpret data to make recommendations to leadership
  • In and /or out-of-town travel as deemed necessary by business need
  • Strong organizational skills and multitasking abilities

Physical and Mental Requirements:

  • 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, UHG, Bilingual, RN, Registered Nurse, Utilization Review / Management, Prior Authorization, Managed care, Case Management / Manager, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX

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