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 and start doing your life's best work.(sm)

The Manager, Utilization Management for the STAR Kids program will manage staff that supports care of members in their homes or other community settings by completing in-person health assessments and coordinating patient care, focusing on disease management and keeping members healthy and independent.

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

Primary Responsibilities:

• Oversees determination for medical necessity for LTSS Long Term Support and Services
• Support clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
• Engage in case management and coordination of care, supporting Service Coordinator team members in the field
• Takes lead role in setting direction and participating in or 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 Texas
• 5+ 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
• 2+ years Pediatric populations experience 
• 2+ years demonstrated Management experience with responsibility for team performance management
• Experience analyzing and make recommendation for process improvement
• Intermediate skills with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
• Intermediate PowerPoint experience presenting to leadership and management

Preferred Qualifications:

• BSN
• Certified Case Manager (CCM)
• Medicare and / or Medicaid experience
• Case Management experience
• Experience / exposure with discharge planning
• Experience in utilization review, concurrent review and / or risk management
• Experience with MDCP (Medically Dependent Children’s Program) or CCP (Community Coalition Programs)
• Background in managed care

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*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: 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.