Utilization Management Specialist

1 day ago

Minneapolis, United States Optum Full time
Job Description

Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Utilization Management Specialist collaborates with the care team to confirm the level of care and authorization for services. Reviews medical records and prepares clinical reviews for medical necessity and authorization. Is also responsible for facilitating the denial and appeal process.    

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. 
  

Primary Responsibilities: 
 
Ensures the appropriate mental health/behavioral health and addiction services are medically necessary and at the appropriate level of care per health plan benefits and patient care needs.

  • Assesses clinical data from medical records to assure appropriateness of patient's admission
  • Utilizes screening criteria to determine patient status
  • Assures the medical record has the proper physician order and/or clinical documentation
  • Monitors continued stay to identify potential issues and communicates results and opportunities to Allina Health System Behavioral Mental Health and Addiction Services Department staff, leadership, physicians and case manager.
  • Evaluates potential denials or payment issues and initiates communication with physician or clinician regarding next steps
  • Prepares and facilitates appeals for denied claims
  • Facilitates peer to peer requests between admitting, attending physician, and the payer physician
  • Other duties as assigned
      
    You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 
Required Qualifications: 
  • Licensed Social Worker – Minnesota Board of Social Work, or Licensed Marriage and Family Therapist- Minnesota Board of Family Therapy, or Licensed Professional Clinical Counselor- Minnesota Board of Behavioral Health and Therapy, or Registered Nurse- Minnesota Board of Nursing.  All licensure in good standing, unrestricted
  • 2+ years of experience direct care experience in an acute hospital behavioral health/mental health setting, or free-standing treatment center
  • 1+ years of experience using diagnostic and statistical manual (DSM) documentation standards
Preferred Qualifications:
  • Dual Licensure with one of the required licensures and a Licensed Alcohol and Drug Counselor – LADC- Minnesota Board of Behavioral Health and Therapy in good standing/unrestricted
  • 2+ years of Mental Health and Addiction care management, and/or Utilization Management experience within an acute hospital system or insurance/managed care organization
  • Epic Experience
  • Knowledgeable in American Society of Addiction Medicine (ASAM) and substance abuse levels of treatment
  *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.   The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.   At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.        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. 

  • Utility Project Specialist

    2 weeks ago

    Minneapolis, Minnesota, United States Excel Engineering Full time

    Job Title: Utility Project SpecialistExcel Engineering is seeking a skilled Utility Project Specialist to support our Power Utility Client in Minneapolis, MN.Assist in managing and coordinating engineering projects.Develop and manage project schedules, budgets, and resource allocations.Conduct feasibility studies and risk assessments.The ideal candidate will...

  • Senior Energy

    1 day ago

    Minneapolis, United States Pioneer Management Consulting Full time

    Job DescriptionJob DescriptionAs a Senior Consultant – Energy & Utilities, you will be a part of a growing team working in a fast-paced environment to help clients solve complex issues and deliver exceptional results. You are a self-driven management consultant who excels at guiding organizations to accomplish their strategic objectives through execution...

  • Principal Energy

    2 months ago

    Minneapolis, United States Pioneer Management Consulting Full time

    As a Principal Consultant - Energy & Utilities, you will be a part of a growing team working in a fast-paced environment to help clients solve complex issues and deliver exceptional results. You are a self-driven management consultant who excels at guiding organizations to accomplish their strategic objectives through execution excellence. You have the...

  • Principal Energy

    1 day ago

    Minneapolis, United States Pioneer Management Consulting Full time

    Job DescriptionJob DescriptionAs a Principal Consultant - Energy & Utilities, you will be a part of a growing team working in a fast-paced environment to help clients solve complex issues and deliver exceptional results. You are a self-driven management consultant who excels at guiding organizations to accomplish their strategic objectives through execution...

  • Environmental Permitting Specialist

    1 month ago

    Minneapolis, Minnesota, United States Merjent Full time

    Company OverviewMergent, Inc. is a medium-sized consulting company dedicated to creating an environment where both people and projects succeed.Salary and BenefitsThe anticipated salary for this full-time position is between $87,600 and $119,000, depending on qualifications and experience.All full-time employees begin their tenure at Merjent with 4 weeks of...

  • Customer Success Utilization Manager

    5 days ago

    Minneapolis, United States Karl Storz Endoscopy-America Full time

    Customer Success Utilization Manager - Minnesota/Wisconsin at KARL STORZ Endoscopy - America summary: The Customer Success Utilization Manager plays a vital role in driving the adoption and successful utilization of innovative healthcare technologies within operating rooms. With a focus on delivering exceptional customer experiences and collaborating with...

  • Category Management Specialist

    2 weeks ago

    Minneapolis, Minnesota, United States Advantage Solutions Full time

    Job DescriptionWe are looking for a Category Management Specialist to optimize new product introductions, distribution, shelving, pricing, and promotional strategies across a group of customers and clients. The successful candidate will utilize broad ranges of data metrics, tools, and analytics to identify opportunities and deliver insights to customers and...

  • Customer Success Utilization Manager

    1 month ago

    Minneapolis, United States Karl Storz Endoscopy-America Full time

    We're seeking a highly skilled and motivated Customer Success Utilization Manager to join our team in the Minneapolis or Wisconsin area! As a field-based role, you'll have the opportunity to work with top healthcare organizations, driving the adoption and utilization of our cutting-edge technologies in Operating Rooms and Video installations. As a Customer...

  • Customer Success Utilization Manager

    1 week ago

    Minneapolis, United States KARL STORZ Endoscopy - America Full time

      We're seeking a highly skilled and motivated Customer Success Utilization Manager to join our team in the Minneapolis or Wisconsin area! As a field-based role, you'll have the opportunity to work with top healthcare organizations, driving the adoption and utilization of our cutting-edge technologies in Operating Rooms and Video installations.   As a...

  • Customer Success Utilization Manager

    1 month ago

    Minneapolis, United States KARL STORZ Endoscopy - America Full time

      We're seeking a highly skilled and motivated Customer Success Utilization Manager to join our team in the Minneapolis or Wisconsin area! As a field-based role, you'll have the opportunity to work with top healthcare organizations, driving the adoption and utilization of our cutting-edge technologies in Operating Rooms and Video installations.   As a...

  • Energy and Utilities Transformation Expert

    1 month ago

    Minneapolis, Minnesota, United States Pioneer Management Consulting Full time

    About Pioneer Management ConsultingPioneer Management Consulting is a leading management consulting firm that helps organizations achieve their strategic objectives through execution excellence.

  • Customer Success Utilization Manager

    1 month ago

    Minneapolis, United States Karl Storz Endoscopy-America Full time

    We're seeking a highly skilled and motivated Customer Success Utilization Manager to join our team in the Minneapolis or Wisconsin area! As a field-based role, you'll have the opportunity to work with top healthcare organizations, driving the adoption and utilization of our cutting-edge technologies in Operating Rooms and Video installations. As a Customer...

  • Project Management Specialist

    2 weeks ago

    Minneapolis, Minnesota, United States Excel Engineering Full time

    Job DescriptionWe are seeking an experienced Project Management Specialist to join our team in Minneapolis, MN.The ideal candidate will have a strong background in project management, with a focus on industrial, manufacturing, utilities, or renewables sectors.Key Responsibilities:Manage and oversee engineering projects from inception to...

  • Customer Success Utilization Manager

    1 month ago

    Minneapolis, United States KARL STORZ Endoscopy - America Full time

      We're seeking a highly skilled and motivated Customer Success Utilization Manager to join our team in the Minneapolis or Wisconsin area! As a field-based role, you'll have the opportunity to work with top healthcare organizations, driving the adoption and utilization of our cutting-edge technologies in Operating Rooms and Video installations.   As a...

  • Customer Success Utilization Manager

    1 month ago

    Minneapolis, United States KARL STORZ Endoscopy - America Full time

      We're seeking a highly skilled and motivated Customer Success Utilization Manager to join our team in the Minneapolis or Wisconsin area! As a field-based role, you'll have the opportunity to work with top healthcare organizations, driving the adoption and utilization of our cutting-edge technologies in Operating Rooms and Video installations.   As a...

  • Pain Management Specialist

    4 weeks ago

    Minneapolis, Minnesota, United States minnesota rehabilitation medicine associates Full time

    Job OverviewAt Minnesota Rehabilitation Medicine Associates in Minneapolis, MN, we are seeking a dedicated and experienced Pain Management Specialist to join our dynamic practice. This role will play a crucial part in providing exceptional care to our patients, utilizing your expertise in chronic pain management to make a positive impact.Compensation...

  • Utility Program Development Manager

    4 weeks ago

    Minneapolis, MN, United States System One Full time

    System One is actively seeking a Utility Program Development Manager for a long-term contract position working a hybrid schedule located in Minneapolis, MN. Are you the right applicant for this opportunity Find out by reading through the role overview below. Utility Program Manager Responsibilities: Product/project development organization. Develop...

  • Organ Utilization Coordinator

    20 hours ago

    Minneapolis, United States LifeSource Full time

    LifeSource is hiring an Organ Utilization Coordinator (OUC) to manage logistics for organ donation opportunities. The OUC will be responsible for responding to calls and notifications regarding organ donation placement, executing logistical coordination with stakeholders to optimize donation and transplantation opportunities. Not sure what skills you will...

  • Energy Systems Optimization Specialist

    1 week ago

    Minneapolis, Minnesota, United States Management Business Solutions Full time

    Job Title: Energy Systems Optimization SpecialistManagement Business Solutions is seeking an experienced Energy Systems Optimization Specialist to join its team in Minneapolis, MN.The ideal candidate will have a strong background in project management principles, including budgeting, scheduling, and resource allocation.The salary for this position is...

  • Utility Scale Solar Lead

    1 month ago

    Minneapolis, Minnesota, United States Spencer Ogden Full time

    Utility Scale Solar LeadEstimated Salary: $160,000 - $200,000 per yearJob Summary:We are seeking an experienced Utility Scale Solar Lead to oversee the development and implementation of large-scale solar projects for our clients. The successful candidate will have a strong background in solar energy development, with a focus on utility scale solar...