RN Manager Delegation Management UM Programs San Antonio Texas

Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.  

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.

Primary Responsibilities:

• 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

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:

• 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 a minimum of 3 years of 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
• Advanced experience using Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays

Preferred Qualifications:

• BSN degree
• 3+ years of utilization management experience

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

The salary range for this role is $71,600 to $140,600 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.