Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. In this leadership role, you will oversee a critical training and quality organization supporting utilization management operations across a large, geographically dispersed healthcare environment. Leading a team of approximately 12 clinical and non-clinical professionals across onshore and global locations (including the U.S., Manila, and Puerto Rico), you will be accountable for onboarding, ongoing education, quality assurance, content management, and process improvement supporting over 500 commercial and enterprise clients nationwide. Leveraging platforms such as EQT and Thought Industries, you will serve as a strategic operational leader driving quality standards and clinical education across utilization management, physician advisor functions, peer-to-peer review support, and appeals operations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: • Lead and develop a multidisciplinary team of approximately 12 clinical and non-clinical training and quality auditor professionals across onshore and global locations • Support ongoing education including cross training education efforts across the existing ~400 FTEs in the Optum Physician Advisor & Utilization management team • Direct the end-to-end design, development, enhancement, and delivery of training programs for new hire onboarding and ongoing operational education • Establish and oversee quality assurance processes, performance metrics, and audit dashboards across clinical and non-clinical utilization management workflows • Align training and quality initiatives with medical necessity guidelines, denial management protocols, physician advisor activities, and peer-to-peer review processes • Partner with stakeholders across physician, nursing, and operational teams to drive continuous quality improvement and address clinical knowledge gaps • Oversee learning platforms and dashboard technologies (e.g., EQT tool, Thought Industries platform) to maintain high-quality learning content and track performance indicators • Manage global, multi-site operational standards across distributed teams to ensure high quality and client satisfaction across 500+ commercial and enterprise clients You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Optum Home & Community Care is part of UnitedHealth Group and provides telephonic case management services to help members navigate the health care system and access support services. As an RN Case Manager, you would assess members' health status, identify gaps in treatment plans, establish care goals, coordinate with multidisciplinary teams including mental health clinicians, provide patient education and coaching, make referrals to community resources, and facilitate transitions between care settings—primarily through phone calls in a high-volume customer service environment.
