Lvn Utilization Management Compliance

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)

The LVN Utilization Management Compliance (Remote) is under the direction of the Manager of Delegation Compliance, this position is responsible for activities that support Optum Clinical Services compliance with regulatory and delegation contractual requirements as outlined in the Clinical Services Compliance framework that includes management of delegation oversight and regulatory audits, internal monitoring, corrective action plan development and resolution.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (Utilization Management and Case Management)
• Performs Appeal processing as applicable
• Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Performs internal monitoring/auditing process as applicable
• Serves as a liaison between Delegation Compliance and cross-functional areas/departments across the organization
• Participates in educational programs to enhance care management (UM and CM) compliance knowledge
• Leverages knowledge of clinical services regulatory and delegation requirements to represent Optum Clinical Services appropriately while managing delegation oversight audits
• Serves as a subject matter expert regarding Clinical Services Policies and Procedures
• 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
• In collaboration with the Manager of Delegation Compliance Clinical Services, manages delegation oversight and regulatory audits

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
• 3+ years of clinical experience working as an LVN/LPN
• Current LVN/LPN license in state of residence
• 2+ years of care management, utilization review (prior authorization) or discharge planning experience

Preferred Qualifications:

• Experience in an HMO or experience in a Managed Care setting
• Base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of business

Already Fortune 5, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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

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.