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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Under the general direction of the Delegation Oversight Manager, this position is responsible for coordinating all components of Health Plan Delegation Oversight audits and performing internal quality reviews for Case Management and Utilization Management.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Hours for the role are Monday through Friday 8AM-5PM
Primary Responsibilities:
- Prepares and submits of pre-audit documentation as outlined on Health Plan audit tools
- Communicates with Health Plan auditors related to audit documents and processes
- Communicates and collaborates across the organization to gather necessary documentation to meet audit requirements
- Facilitate onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence
- Participates in performance improvement activities
- Conduct comprehensive internal audit of the end-to-end utilization management process
- Conduct focused internal audits of a specific element or process change based on identified trends or new process implementation
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:
- Graduation from an accredited Licensed Vocational/Practical Nurse program or completion of vocational nursing program through the CA Board of Nursing
- Current LVN/LPN license
- 2+ years of clinical experience working as an LVN/LPN
- 1+ years of utilization management experience especially Prior Authorization
Preferred Qualifications:
- 3+ years of experience working as an LVN/LPN
- 2+ years of care management, utilization review or discharge planning experience
- Experience in an HMO or experience in a Managed Care setting
- A base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of business
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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 hourly pay for this role will range from $20 - $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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.