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Under the direction of the Manager of Delegation Oversight Internal Monitoring, 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:

• Consistently exhibits behavior and communication skills demonstrating Optum’s commitment to superior customer service, including quality, care, and concern with every internal and external customer
• Monitor and evaluate the accuracy and consistency of Utilization Management (UM), inpatient care management decision-making and processes in accordance with established standards
• Monitor and evaluate the application of review criteria and guidelines, consistency and strength of documentation, use of established hierarchy of medical review resources and evidence-based medicine to ensure ongoing quality and adherence to regulatory standards
• Demonstrates a thorough understanding of utilization and care management decisions through the utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days
• Maintains effective communication with Operational Leaders
• Evaluation of internal audit results to identify opportunities to improve accuracy and consistency with decision-making and documentation
• Follow up audits results on an ongoing basis until performance improves
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

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 Nurse program
• Current LVN license in California
• 1+ years of recent clinical experience working as an LVN/LPN or a role supporting a quality function or related operational function

Preferred Qualifications:

• 3+ years of clinical experience working as an LVN/LPN
• 1+ years of case management or care management, utilization review or discharge planning experience in a Managed Care setting

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all 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.  

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

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.

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