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Manager Regulatory Adherence - Remote PST Only

Company: UnitedHealth Group
Location: Indianapolis
Posted on: November 16, 2023

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 to start -Caring. Connecting. Growing together. -
Responsible for oversight and management of the processes and staff supporting Optum Clinical Services compliance with regulatory and delegation contractual requirements for the California Market. Works with the Director of Delegation Oversight Clinical Services to implement and maintain the Clinical Services compliance framework that includes management of delegation oversight and regulatory audits, internal monitoring, corrective action plan development and resolution. The collaborative effort includes but is not limited to partnering with Utilization Management (UM) and Care Management (CM) leadership on process improvement initiatives to support compliance.
If you are able to work PST hours, you'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. -

Primary Responsibilities:

  • Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each internal and external customer
  • Serves as a subject matter expert to cross-functional staff regarding clinical services regulatory and delegation requirements, and impact to operational processes
  • Serves as a subject matter expert regarding Clinical Services Policies and Procedures
  • Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (UM and CM)
  • Serves as a liaison between Delegation Oversight and cross-functional areas/departments across the organization
  • Provides ongoing coaching, mentoring and professional development opportunities to Delegation Oversight staff to deepen their understanding of regulatory and delegation requirements, audit management processes, delegation reporting and Utilization Management and Case Management operational processes
  • Serves as a role model for Delegation Oversight staff for relationship management with internal and external stakeholders
  • Participates in the documentation effort of department workflow processes to ensure clarity and appropriate training with respect to specific tasks and job requirements
  • Participates in educational programs to enhance care management (utilization management and case management) compliance knowledge and ensures staff participation as well
  • Manages internal monitoring/auditing staff and process
  • Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Performs additional 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.One year of post-high school education can be substituted/is equivalent to one year of experience.
    Required Qualifications:

    • 3+ years of experience working in a healthcare related field: utilization management and/or case management and/or Compliance
    • 3+ years of Managerial experience managing people or projects -
    • Intermediate to Advance experience with MS Office including Word, Excel and PowerPoint
    • Basic to Intermediate SharePoint experience including utilization and site maintenance (or like document management system / repository)
    • Dynamic verbal and non-verbal communicator who can create and maintain a collaborative work environment with critical business partners including executive leadership

      Preferred Qualifications:

      • Active RN or LVN License (Any State)
      • 1+ year in a role supporting a quality function or related operational function
      • Experience specifically working in an Operations Environment

        Soft Skills:

        • Excellent written and verbal communication and presentation skills
        • Ability to create and support a team environment
        • Ability to interface with all levels of management
        • Effective organizational, multi-tasking and follow-up skills
        • Ability to transfer knowledge to customers with diverse cultural backgrounds, educational experience and learning styles.

          *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy -

          California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California/Colorado/Connecticut/Nevada/New Jersey/New York/Rhode Island/Washington residents is $85,000 to $167,300 annually. 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.

          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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
          OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Indianapolis , Manager Regulatory Adherence - Remote PST Only, Executive , Indianapolis, Indiana

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