Assoc Director Utilization Mgmt - Pittsburgh/Trumbull

Company: UnitedHealth Group ( Learn More )

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General Information
US-CT-Trumbull
N/A
4 Year Degree
Full-Time
At least 4 year(s)
Not Specified
False
False
Job Description The primary responsibility of this Director will be the oversight of multiple Community and State Health plans that encompass the NE region including: NY, NJ, PA, MD.  Some of the specific responsibilities will include the following: Ensures Prior Authorization process is compliant.  Overseeing and leading process improvement efforts for UM team. Frequent, regular communication and collaboration with other Regional Directors to ensure business standardization, work distribution efforts, etc. Management, development and performance of 3 Clinical Managers to the Healthplans. (CM =Nurses that perform clinical review, on preservice requests, apply clinical criteria to detemine medical necessity on services, etc.) Responsible for 60 indirect reports under the Clinical Managers. Responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). Performs reviews of current inpatient services. Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
Job RequirementsCurrent unrestricted, licensed BSN/RN required 4 or more years experience managing operations, including building and leading teams for process execution required Experience with Utilization Management and/or Prior Authorization processes Experience ensuring processes effectively maintain compliance within regulated timeframes Proficiency with Word, Excel, Powerpoint is required Strong, committed work ethic and dedication to achieving optimal results Knowledge of clinical criteria preferred (i.e. Milliman) Working knowledge of compliance with state & federal regulations preferred 1 or more years experience in process improvement activities preferred Demonstrated ability to effectively executive on specific timeframes for deliverables Experience effectively leveraging staff efforts around workflow management requirements preferred Experience working with large group (20+) highly preferred Experience with Visio is a plus 1 or more years experience leading, building a collaborative team preferred Strong leadership and communication skills Critical thinker and problem solver Strong influential leader Less than 5% travel necessary   UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.   Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.   Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives. Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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