Supervisor, Utilization Management Professional

4 weeks ago


Irvine, California, United States Optum Full time

Optum is seeking a Supervisor, Utilization Management to join our team in a dynamic and collaborative environment.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home.

Key Responsibilities:

  • Exercise a leadership role in the direction, monitoring, and support of the UM Department in collaboration with the UM Manager and Director of UM.
  • Ensure that all UM functions are staffed appropriately and ensures coverage for sick and vacation absences; monitors time card accuracy.
  • Participate in regularly scheduled UM Committee meetings, JOC's with health plans and vendors, department meetings, health plan audits, and interdepartmental meetings as required.
  • Develop specific and measurable competencies and key performance indicators (KPIs) for prior authorization functions and assess all UM staff for deficiencies.
  • Conduct necessary interventions to improve overall performance of UM staff.
  • Develop job aides for UM staff that have direct impact on the day-to-day operations and flow of information between departmental business units.

Requirements:

  • Graduate from an accredited school of Nursing.
  • Current, unrestricted RN or LVN license in California.
  • 2+ years of experience in utilization management or (prior authorization review) nurse.
  • 1 + years of experience in managed care.

Preferred Qualifications:

  • Bachelor's Degree in healthcare administration or other healthcare related field.
  • 1+ years of experience in a leadership role.

About Optum:

Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.



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