Manager, LTSS Utilization Management - Remote in MI

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Michigan LTSS Utilization Management Manager will be responsible for creating a utilization management program that supports our care coordination team in determining appropriate service level authorizations for waivered home-based case services (HBCS). After implementation, the manager will have program management, audit and oversight duties related to day-to-day operations, policies & procedures and quality alignment to ensure utilization management and case management functions are streamlined and effective. to staff that supports care of members by completing face-to-face or telephonic health assessments focusing on complex care management and keeping members healthy and independent.

There is a solid focus on addressing racial disparities, delivering person-centered care, collaboration with the county and community organizations and creating innovation and value within our programs. This position will not have any direct reports.

If you are located in the state of Michigan, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities

• Oversight of medical necessity determinations for LTSS Long Term Support and Services
• Support clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
• Engage in collaborations with case management and coordination of care, supporting Service Coordinator team members in the field
• Takes lead role in setting direction and participating in developing new programs
• Sets team direction, resolves problems and provides guidance to members of the team
• Ensures team meets established performance metrics and performance guarantees
• Adapts departmental plans and priorities to address business and operational challenges
• Plans, organizes, and oversees staff to ensure timely completion of assessments
• Oversees the department's daily staffing requirements to meet program standards
• Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
• Other duties as assigned to support team
  
  

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

• Current, unrestricted RN license in the state of Michigan
• 2+ years of RN experience of in a hospital setting, acute care, direct care case management, home health care or clinical experience in acute / rehab / or long - term care setting
• 1+ years of Utilization Management experience
• 1+ years of experience addressing health inequities within a health plan, clinical practice or in a community setting
• Intermediate skills with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
• Reliable transportation and ability to travel up to 25% locally to meet with members and providers
• Live in Michigan
  
  

Preferred Qualifications

• BSN
• Experience in managed care
• Medicare and / or Medicaid experience
• Case Management experience
• Experience / exposure with discharge planning
• Experience in utilization review, concurrent review and / or risk management
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. 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: 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.