RN Supervisor Preservice Review - Telecommute - Western US preferred
UHG , CA
About the Job
Optumcare is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optumcare’s focus is to do the right things for patients, physicians, and the community. Optumcare Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of Optumcare is on seniors, and those with complex care needs, who most benefit from a high touch model of care.
The RN supervisor is responsible for ensuring customer service goals are met through supervision of staff and effective workflow processes, to include prior authorization, census management and concurrent review (telephonic). The RN Supervisor is responsible for managing and coordinating the daily activities, team performance, and day-to-day operations for up to 10 employees. In addition, the RN Supervisor will also perform reviews, to include prior auth and concurrent review; and act as a liaison with Medical Directors.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Clinical and staffing oversight of professional nursing staff and non-clinical coordinators
- Education of clinical staff (clinical criteria review, related policies and procedures)
- Monitor work queues to ensure turnaround time compliance timeframes are met
- Manages training of new employees, both clinical and non-clinical
- Identifies areas of opportunity for process improvement
- Monitors compliance with policies, procedures, laws and regulations
- Performing performance reviews on an annual basis and one-to-one meetings on a monthly basis
- Performing quality reviews on a quarterly basis (Inter-rater Reliability)
- Ability to communication clearly both verbally and in writing
- Handle shifting priorities
- Current unrestricted RN license
- 2+ years Utilization Management experience in managed care, acute, or rehab setting desired
- Minimum of 1 year of supervisory experience
- Knowledge of utilization review process and prior authorization process in a managed health care industry
- Knowledge of ICD10 and CPT coding
- Knowledge of CMS and Milliman Care Guidelines and how to apply them for decision making
- Solid organizational and decision making skills
- Strong interpersonal, staff development and team building skills
- Intermediate Windows applications skills
- Knowledge of compliance and regulatory requirements
- Associate or bachelor’s degree in nursing
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: RN, Supervisor, Team Lead, Prior Authorizations, Acute Care, Managed Care, Utilization Management, CPT/ICD-9 Coding, Milliman, California, CA, Washington, WA, Oregon, OR, Arizona, AZ, Nevada, NV