Assc Dir Med Clin Ops - Brentwood, TN - Full-time / Part-time

Clinical Operations career's at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Our Directors of Clinical Operations support field clinicians and clinical leadership to ensure members receive services in a timely manner through oversight of the clinical authorization and customer service functions.  Join us. And start doing your life's best work.(sm)

Primary Responsibilities:

• Oversight of the authorization team, to include member authorization, provider service coordination, and root cause analysis of authorization issues impacting claims payment


• Specific duties include direct oversight of a team of 35 FTEs with ownership of the CHOICES LTSS end to end authorization and customer services, and enrollment processes


• LTSS Authorization Processes:
  
  
  
  • Electronic Visit Verification for home and community based (HCBS) members to include authorizations, claims issue identification and resolution, and modification to authorization processes
  
  
  • Authorization process for short-term stays, inpatient respite, inpatient services, and skilled nursing services
  
  
  • Member preferred scheduling and changes
  
  
  • Membership services for new and existing members to include HCBS service holds and resumption for short-term stays, and member dis-enrollment, as necessary  
  
  
  • Consumer direction (CD) referrals and authorization for new CD enrollment
  
  
  • Authorization and coordination of minor home modification (MHM) and assistive technology (AT)


• LTSS Member Services & Enrollment Processes:
  
  
  
  • Customer service to include provider and member support for the electronic visit verification process
  
  
  • CHOICES LTSS telephonic eligibility screening:
  
  
  • New member intake process including new member assignment to clinical team based on geographic regional and coordination and authorization of new member services


• Vendor Relationship Ownership:
  
  
  
  • Act as the vendor relationship owner for EVV and Silverlink, e.g., to ensure vendor oversight activities meet contractual guidelines


• Regulatory Reporting:
  
  
  
  • Develop and meet contractual reporting obligations related to area of accountability, and participate as a subject matter expert on contract changes and deliverables, as required to meet contractual and customer expectations

Required Qualifications:

• 4 year degree


• 3-5 years of clinical authorization process oversight


• 3-5 years of customer/provider call center oversight

Preferred Qualifications:

• Experience in Managed Medicaid Long Term Services & Supports  


• 3 to 5 years clinical operations experience to include managing a call center, entering, reviewing, and adjusting authorization for services within a highly effective and collaborative matrix environment 


• CHOICES Long Term Services and Supports (Managed Medicaid Long Term Care), TennCare/Medicaid, and Medicare experience

 
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)

Diversity creates a healthier atmosphere: 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.