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If you are in San Antonio, TX, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. 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 Manager of Utilization Management Operations is responsible for driving cost effective, quality of care services for members through daily coordination among medical directors, UM staff, the provider network and various other departments. This position is also responsible for overseeing all compliance functions, the denial and appeal process and for providing administrative and leadership support to staff in accordance with policies and procedures.

Manager would be responsible for the management of the supervisors, initiative management, develops plans to meet short-term objectives for the overall team, identifies and resolves operational problems using defined processes, expertise and judgement. Decisions would be guided by policies, procedures and business plan. The Manager would coordinate work activities with supervisors. The manager would set priorities for the team to ensure task completion.

This position is full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm but might differ depending on the workload. It may be necessary, given the business need, to work occasional overtime.

Our office is located at 19500 IH 10 W Building 1 San Antonio TX 78257. Employees will be required to work 2 days onsite and 3 days from home.

We offer 8-12 weeks of paid training. The hours during training will be 8am to 5pm, Monday – Friday. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Performs daily oversight of the UM Supervisors.
• Manages the compliance for UM queues to meet established performance metrics and service timeframes.
• Conducts routine audits on UM reviews to ensure adherence to CMS regulations.
• Produces daily, weekly and monthly operational reports for senior leaders.
• Organizes and presents at staff meetings and provide education on utilization management processes.
• Applies employee performance management techniques through job-related coaching, training and development activities.
• Actively work with Director on talent reviews to plan for future growth with regard to career roles.
• Partner with Prior Authorization, Specialty Drug Review, Medical Directors, and other departments to improve satisfaction strategies.
• Oversee departmental process improvement initiatives on a continual basis.
• Develop staff communications and partners with Training for training needs.
• Coordinate departmental projects, effectively managing resources in the process.
• Handle escalated customer issues according to company policy.
• Utilize departmental data and information to analyze trends and identify opportunities for improvement.
• Performs all other related 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:

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years in a supervisory capacity experience
• 2+ years of healthcare experience (administrative or medical records)
• Proficiency with Microsoft Office applications
• Knowledge of medical terminology, ICD and CPT
• Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm but might differ depending on the workload. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 2+ years of managed care experience in Prior Authorization

Telecommuting Requirements:

• Reside within commutable distance of San Antonio, TX
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

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.

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