Utilization Management Manager - Remote in Idaho

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Utilization Management (UM) Manager is responsible for the supervisory oversight and direction of UM department activities to include prior authorization for post-acute services, medical necessity determinations, concurrent and retrospective reviews and discharge planning functions. The UM Manager actively participates in management decisions to verify compliance with all contract requirements. This position is based in Idaho but can be worked remotely.

If you reside in Idaho, you will have the flexibility to work remotely

• as you take on some tough challenges.

Primary Responsibilities :

Directs the activities of the UM staff, with direct supervision by the medical director regarding prior authorization, medical necessity determinations, concurrent review, retrospective review, appropriate utilization of health care services, continuity of care and other clinical and medical management programs

Aids, approves and intervenes, as needed, to determine medical necessity, appropriateness and extended length-of-stay decisions

Assists inpatient care manager in UM of members with complex medical care involving numerous providers or frequent intervention

Participates in State- or plan-required audits and complies with all reporting requirements by area of responsibility

Oversees reporting and monitors potential high-cost cases, readmissions, UM statistics to include admits per thousand, bed days per thousand, length-of-stay and readmissions per thousand within 30 days of discharge

Develops and implements action plans for improvement, as needed

Liaisons with the national UM team to ensure use of best practices and adherence to state contract requirements

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 RN license in the State of Idaho

5+ years of relevant experience in Utilization Management

3+ years of experience with Medicaid and Long-Term Services and Supports (LTSS), may include work with the MLTSS population

Intermediate proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Outlook) and ability to navigate in a Windows environment

Willingness to work weekends and holidays on a rotational basis

Access to a designated workspace and high-speed internet at home

Ability to travel up to 10% to the office, as needed

Resident of Idaho

Preferred Qualifications :

Undergraduate degree

Certified Case Manager (CCM)

Utilization Management and Case Management experience

Experience in a supervisory role within a managed care environment

Bilingual in Spanish / English or another language relevant to the market and region

Proven background in managed care

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.