Utilization Management (UM) Manager – Telecommute in OK

UnitedHealth Group
April 8, 2021
Atlanta, GA
Job Type


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)

You’ll enjoy the flexibility to telecommute* in Oklahoma as you take on some tough challenges.

Primary Responsibilities:

  • Oversees determination for medical necessity for Oklahoma Medicaid members
  • 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 Registered Nurse (RN) license in the State of Oklahoma
  • 4+ 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 of demonstrated management experience with responsibility for team performance management
  • 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
  • Experience analyzing and making recommendations for process improvement
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

  • Bachelor of Science in Nursing (BSN)
  • Background in managed care
  • Medicare and/or Medicaid experience
  • Case Management experience
  • Certified Case Manager (CCM)
  • 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)

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 Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter policy.

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.   

Job Keywords: RN, Registered Nurse, Manager, Management, Manage, MDCP, CCP, CCM, Case Management, Case Manager, UM, Utilization Management Manager, BSN, Managed Care, Concurrent Review, Risk Management, Pediatric Nursing, Acute, Rehab, Long Term Care, Medicaid, Medicare, Discharge Planning, Oklahoma City, OK, Oklahoma

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