Manager Utilization Management - Arizona

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)

The Manager of Utilization Management will oversee 3 lines of business, Medicaid, Medicare, and Commercial. In this role, the Manager is responsible for utilization management function  which includes Concurrent Review (on-site or telephonic Inpatient Care Management).  This function performs reviews of current inpatient services and  determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

Primary Responsibilities:

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  This is a supervisory role accountable for staffing levels, training, hiring, performance review process and others as assigned


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  Manages and is accountable for professional employees and/or supervisors


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  Performs daily oversight for the UM Supervisors


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  Manages the compliance for UM phone queue to meet established performance metrics


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  Manages all aspects of the UM claim review inventory and service timeframes


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  Manages all aspects of the denial and UM correspondence inventory and service timeframes


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  Produces daily, weekly and monthly operational reports for senior leaders


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  Organizes and presents at staff meetings and provider education sessions on utilization management processes


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  Applies employee performance management techniques through job-related coaching, training and development activities


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  Performs all other related duties as assigned

Required Qualifications:

Preferred Qualifications:

• 3 years in a supervisory role in Utilization Management in a managed care environment or one year of experience as a Senior ICM role with a Meets or Above Meets MAP rating


• Case management certification and/or experience


• Solid computer skills


• Ability to build and maintain relationships is essential


• Effective communication skills, flexibility and displays positive attitude


• Undergraduate degree


• Familiar with the utilization of criteria based decision making tools, such as Milliman Care Guidelines, InterQual or other criteria-based guidelines

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.

Job Keywords: Manager, Utilization Management, UM, RN, Registered Nurse, Milliman Care, Managed Care, Tucson, AZ, Arizona