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Job Location : , USA

Posted on :

Job Description :
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Primary Responsibilities:
  • Assist in developing the utilization management claims outlier program
  • Identify and implement business development opportunities based on data analytics to support growth of clinical operations and new services
  • Assist with policies, procedures and guidelines for clinical operations program
  • Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
  • Monitor compliance against relevant utilization management process requirements (e.g., turnaround time)
  • Review and interpret laws and regulations and determine their applicability in a given situation
  • Perform, assist with, or oversee audits (e.g., clinical, financial, external, regulatory, process, compliance, quality)
  • Collect and submit data to relevant agencies for accreditation or compliance review
  • Gather data and respond to customer, regulatory, or internal evaluation requests (e.g., to identify opportunities for improvement)
  • Intervene in resolution of member or provider complaints, interpret data reports to ensure compliance of clinical operations to evaluate contractual requirements for programs and services
  • Provides supervision of care advocacy staff to ensure timeliness and appropriateness of clinical utilization management reviews are conducted in accordance with OptumHealth clinical guidelines and care coordination processes
Required Qualifications:
  • Bachelor’s degree level of education or higher (healthcare or business related field preferred)
  • 5+ years experience in a healthcare setting, preferably behavioral health
  • 1+ years of supervisory or leadership experience
  • Proficiency with MS Office applications
  • Must live within a commutable distance of our Meridian, ID office location
Preferred Qualifications:
  • MBA or other related Master’s level degree
  • Knowledge of principles and practices of public and commercial mental health service delivery systems
  • Demonstrated competence in State and Federal laws and regulations relevant to mental health programs
  • Proficiency in health care utilization management, data analytics and outcomes
  • Project Management experience
  • Previous experience within a managed care organization (MCO)
  • Experience with the Medicaid patient population
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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) 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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