Manager, Medical and Clinical Operations, RN Required – Las Vegas, NV

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)
 
This position has responsibility for oversight of all Prior Authorization Operations including management of staff, compliance with audits, management of state based initiatives, adherence to NCQA/CMS/URAC measures and all administrative services to assure the ongoing work of Optum in Las Vegas, NV.  
   
Primary Responsibilities:   

Manages and is accountable for clinical employees and/or supervisors
Sets team direction, resolves problems and provides guidance to members of own team
Adapts departmental plans and priorities to address business and operational challenges
Influences or provides input to forecasting and planning activities
Monitors, manages and controls operational and performance metrics in conjunction with established program value targets
Develops solutions to address new, often complex customer requirements that address operational, clinical and customer needs
Ensures audits are conducted, standards are met, successful outcome are achieved
Reviews operational and performance metrics regularly and partners with direct supervisor in driving action plan development and execution
Ensures site remains compliance with all applicable regulatory and accreditation requirements (NCQA/URAC/CMS)
Collaborates across UHG including Medical, Site Directors, senior leaders, sales, account management, product organization, and other stakeholders

Required Qualifications:    

Current, unrestricted RN license in the State of Nevada
3+ years of hands-on clinical experience
Demonstrated ability with developing strategic plans, attainable goals, drive performance, and achieve targets
Problem solving skills, detail oriented and highly organized
Strong team building, leadership and mentoring skills
Ability to work in a rapidly changing environment being adaptable and flexible
Proficient in Microsoft Excel, Word, PowerPoint and Outlook
Preferred Qualifications:    

BSN

2+ years of Supervisory or Management experience (including performance management functions i.e. hiring, performance evaluations, corrective action plans etc.)
Managed Care/Insurance experience
Medicare experience
Experience managing a virtual and/or field-based team
Knowledge of Accreditation requirements (NCQA/URAC/CMS)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
 
 
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: BSN, RN, registered nurse, Management, Medicare, NCQA, URAC, CMS, Las Vegas, Nevada