Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
The Regulatory Adherence Manager for the UM Program is responsible for planning, organizing, and directing the assigned regulatory operations for the delegated functions of Utilization Management. The Manager coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines and CMS/URAC/NCQA standards; develops and implements policy and procedures; updates and integrates current clinical practice guidelines; performs employee counseling, performance appraisals, and oversights employee training and development. The success of this position requires the ability to foster communication and teamwork between market care management team, utilization management staff, and department leadership.
- Supervises and coordinates the work activities of the team for all delegated functions in an efficient and effective manner utilizing time management skills to facilitate the total work process
- Monitors audit productivity, processes, and communicates results to department leader
- Provides constructive information to minimize problems and increase customer satisfaction
- Spends time mentoring team members, and provide educational needs as applicable
- Provides effective problem solving, works as a UM program liaison and resource with all customers internal and external to provide optimal customer satisfaction
- Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
- Participates in enterprise activities for execution, monitoring and quality improvement of all care management clinical programs and delegated functions
- Participates in the development, planning, and execution of continual process improvement efforts, policies and procedures, and regulatory compliance functions related to care management activities
- Coordinates all activities related to delegated and regulatory requirements
- Develops initiatives for process improvement of programs
- Develops new policies, procedures, job aids, and work flows that enhance operating efficiency of the regulatory UM program or activities
- Evaluates the success of process improvement efforts and implements solutions for growth opportunities
- Performs all other related duties as assigned
This is an office-based position located near Interstate Highway I-10 West, near West Frontage Road just past The Rim Shopping Center/Ferrrari Dealership, 78257
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.
- Registered Nurse with current license in Texas, with compact license for other participating states
- 3+ years of experience within a healthcare environment including experience within a managed care setting, including 3+ years of management experience
- Advanced experience using Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays.
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
- BSN degree
- 3+ years of utilization management experience
- Proven capability to work with people at all levels in an organization
- Excellent training and presentation skills with solid communication capabilities and practices, both oral and written
- Demonstrated effective organizational skills
- Excellent communication, writing, proofreading and grammar skills
- Solid attention to detail and accuracy, excellent evaluative and analytical skills
- Solid teamwork, interpersonal, verbal, written, and administrative skills
Physical & Mental Requirements:
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
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.