RN Supervisor Preservice Review - Las Vegas, NV - Full-time / Part-time

OptumCare is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. OptumCare's focus is to do the right things for patients, physicians, and the community. OptumCare Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of OptumCare is on seniors, and those with complex care needs, who most benefit from a high touch model of care.
 
The RN supervisor is responsible for ensuring customer service goals are met through supervision of staff and effective workflow processes, to include prior authorization, census management and concurrent review (telephonic). The RN Supervisor is responsible for managing and coordinating the daily activities, team performance, and day-to-day operations for up to 10 employees. In addition, the RN Supervisor will also perform reviews, to include prior auth and concurrent review; and act as a liaison with OptumCare Medical Directors.
 
Primary Responsibilities:


Clinical and staffing oversight of professional nursing staff and non-clinical coordinators

Education of clinical staff (clinical criteria review, related policies and procedures)

Monitor work queues to ensure turnaround time compliance timeframes are met

Manages training of new employees, both clinical and non-clinical

Identifies areas of opportunity for process improvement

Monitors compliance with policies, procedures, laws and regulations

Performing performance reviews on an annual basis and one-to-one meetings on a monthly basis

Performing quality reviews on a quarterly basis (Inter-rater Reliability)

Ability to communication clearly both verbally and in writing

Handle shifting priorities

Required Qualifications:

Current unrestricted RN license in state of Nevada
2+ years of Utilization Management experience in managed care, acute, or rehab setting
Previous leadership experience to include Team Lead, Supervisor or Managerial 
Knowledge of utilization review process and prior authorization process in a managed health care industry
Knowledge of ICD10 and CPT coding
Knowledge of CMS and Milliman Care Guidelines and how to apply them for decision making
Solid organizational and decision making skills
Strong interpersonal, staff development and team building skills
Intermediate Windows applications skills
Preferred Qualifications:

1+ years of experience managing direct reports
Experience coaching and/or mentoring others
Management of remote staff
Knowledge of compliance and regulatory requirements
Associate's or Bachelor's degree in nursing
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: Supervisor, Team Lead, Manager, Leader, Healthcare, utilization management, call center, pre service, prior authorization, Las Vegas, NV, Nevada