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Director of Prior Authorization, Utilization Management - Telecommute

Company: UnitedHealth Group
Location: New York
Posted on: November 26, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) Reporting to the Program Director, the Director of Medical/ Clinical Operations is responsible for business operations for the prior authorization (PA) work stream, including meeting all contract service level agreements and federal and state regulatory requirements. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:

  • Works with the Program Director/COO and Prior Authorization (PA) work stream managers to influence team direction and business goals, resolve problems, and provide strategic and operational guidance
  • Develops relationships with key internal and external constituents to drive market quality and growth
  • Leads and directs all clinical functions to ensure optimal performance
  • Partners with the Program Office to lead and implement department strategic initiatives
  • Drives growth and innovation leveraging Optum enterprise capabilities
  • Improves cost, quality, productivity and value of services we deliver to the Commonwealth of Massachusetts' Executive Office of Health and Human Services (EOHHS)
  • Engages, cultivates and deepens customer relationships
  • Participates in regular meetings to collaborate with supporting departments to ensure operational efficiency
  • Develops policies and procedures to ensure quality and performance meet expectations
  • Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows
  • Ensures enterprise, department, HIPAA, and regulatory compliance: Maintaining security of Protected Health Information (PHI) and Intellectual Property (IP)
  • Represents the MA MLTSS program in a positive, solution focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
  • Minimum 10% travel 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:
    • Current unrestricted clinical licensure in state of Massachusetts, e.g. nursing, physical therapy, occupational therapy, etc.
    • 5+ years of clinical experience
    • 5+ years of related leadership experience with focus on developing a clinical team
    • 5+ years of experience with Long-Term Support Services (LTSS) including durable medical equipment, home health, therapies, adult foster care, adult day/health, personal care attendant, etc.
    • 3+ years of experience working in utilization management or prior authorization
    • Proven experience in developing and sustaining internal and external client relationships with healthcare professionals and community-based organizations
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications:
      • Registered Nurse licensure
      • Certified Case Management certification
      • Experience with SalesForce
      • Solid business acumen including analysis and business planning experience
      • Knowledge of Medicare and Medicaid
      • Proficient computer skills including the ability to document medical information with written and electronic medical records
      • Excellent communication skills and demonstrated ability to foster a culture of clinical excellence and build collaborative relationships
      • Massachusetts resident or commutable distance To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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) Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $113,500 to $218,100. The salary range for Connecticut / Nevada residents is $113,500 to $218,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. 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.

Keywords: UnitedHealth Group, New York , Director of Prior Authorization, Utilization Management - Telecommute, Executive , New York, New York

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