You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- For selected clients, perform regularly scheduled clinical analytical review
- Provide clinical updates on selected cases to include project medical spend trending and care opportunities
- Evaluate variances to, or achievement of, committed metrics consistent with product definitions and performance guarantees
- Evaluate client level medical cost and utilization trends
- Identify program opportunities
- Collaborate with CMC team to make recommendations with defined value to support client population needs
Attend client meetings as requested; Commonly for the purpose of delivering the OptumHealth/UMR value story as part of client level performance and outcomes reporting or finalist meetings
Provide assistance in preparing for all client and external audits
Represent OptumHealth Care Solutions during audits for all program/product questions, operational delivery enhancements, and future planned solutions to identified gaps
- Post audit, contribute to the documentation of issue resolution steps and work with responsible teams to ensure steps are implemented
Monitor key performance indicators for all groups supported, maintaining a client status indicator
For those where the program performance metrics are not being met, ensure corrective action plans are developed, implemented, and communicated to appropriate stakeholders
Other responsibilities, as assigned
RN licensure with 5+ years of experience in a managed care environment
5+ years of experience in operational, problem solving, process development, and consensus building roles in a direct or indirect managed care environment, including multi-functional departments
3+ years of external client facing or customer facing experience
3+ years proven analytics background (gathering data reports, analysis of data, identification of changes, creation of action steps based upon findings)
- Previous clinical product operations experience in utilization management, case management, disease management, or discharge planning
- Knowledge of clinical program design, implementation, management/monitoring
- Data analysis capabilities with strong drive to synthesize the story into an actionable set of recommendations
- Client facing abilities; Ability to translate product and operational design and complex medical situations to non-clinical terms for client understanding
- Ability to translate client business objectives and expectations to scalable sustainable solutions
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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: nurse, RN, case manager, telecommute, remote