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Clinical Coordinator
Help us lead the next revolution in health care.

Clinical Careers at UnitedHealth Group. The days when people only connected with health care when they were sick are over. Today, we’re leading the health care revolution with a growing array of proactive, holistic tools and resources to encourage total well-being for millions of our customers. our integration model and network of over 80,000 providers allows us to affect meaningful change on a huge scale, and positions us well ahead of our competitors. We’re going beyond basic care to health programs integrated across the entire continuum of care. We’re inventing the future of health care. Join us. Change your life by doing your life’s best work.SM

Manager, Utilization Management - Honolulu, HI

Job Description:

Nurse Leadership!  Utilization Management!  Honolulu! 



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)



Office location: 841 Bishop Street, Suite 725


Honolulu, HI 96813



The RN Manager, Utilization Management (UM) is responsible for the management, day to day operations and administration of multiple medical and clinical operations functions.  This position manages and is accountable for both Administrative and RN Supervisors and indirectly supporting the team of UM Nurses. 



Responsibilities:


  • Provide oversight and review of coordination of care

  • Develop/oversee/deliver operational or technical training

  • Develop policies, procedures, and guidelines for clinical operations

  • Review/approve policy and process changes

  • Evaluate regulatory changes and determine steps needed to implement in programs

  • Identify and implement business development opportunities to support growth of medical and clinical operations programs

  • Oversee/navigate technology and software applications utilized in the delivery of clinical operations

  • Oversee management/service delivery systems utilized in member care

  • Intervene in resolution of member or employee complaints or issues as necessary

  • Implement process improvement activities to address areas of non-compliance or ensure procedures are followed

  • Measure employee/provider performance against internal procedures and protocols

  • Ensure team members address gaps in performance against internal procedures and protocols

  • Develop and communicate performance metrics and expectations

  • Direct data collection and measurement of outcomes (e.g., customer surveys)

  • Apply metrics to evaluate services, employee performance, and program outcomes

  • Employee training, mentoring, development and engagement

  • Read and interpret reports (e.g., performance, service)

  • Identify causes of performance deficiencies and determine appropriate follow up actions

  • Drive implementation of best practices and standards

  • Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses

  • Read financial reports, Identify reasons for financial performance gaps, and Identify opportunities for improved financial performance and enhanced return on investment

  • Collect and review data to evaluate financial outcomes of programs and services

  • Conduct cost/benefit analysis on programs to drive efficiencies

  • Conduct competitive analysis and identify opportunities to enhance financial viability

  • Propose and obtain approval for capital expenditures for medical and clinical operations

Job Requirements:

Required Qualifications:

  • Current and unrestricted Hawaii RN licensure

  • Utilization Management experience

  • A minimum of 2 years of experience in a leadership role

  • Computer proficiency with the ability to navigate around a Windows based environment

  • Strong communication skills, written and verbal


Preferred Assets:


  • Case Management experience

  • BSN


  • Experience working in a call center environment

  • Experience with the Medicaid, Medicare or high risk population



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, national origin, protected veteran status, or disability status.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.



Job Keywords: RN, Nurse, UM, Utilization Management, Manager, Leadership, Clinical, Case Management, Medicaid, Medicare, High Risk, Community and State, UHC, UnitedHealthcare, UHG, UnitedHealth Group, Honolulu, HI, Hawaii.   


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Job Category: Management
Health Care
Insurance
Job Reference Code: UHG-544567
Position Type: Full-Time
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  • Manager, Utilization Management - Honolulu, HI @ UnitedHealth Group

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