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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. Schedule: Monday - Friday, standard business hours You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Clinical leadership of assigned Optum products. Accountabilities include: • Research and development of product-specific clinical utilization management guidelines including annual literature/evidence reviews and shepherding the guidelines through the marketing and publication processes • Research and development of selection criteria for products with a centers of excellence (COE) network including annual literature/evidence reviews • Planning and execution of annual expert panel for assigned Optum products. Panels comprise 8-10 external physician care providers/thought leaders in the subject matter • Contribute to decision-making during annual network qualification for assigned Optum products including clinical evaluation of COE network status appeals and quality outcome reviews • Conduct quality of care investigations of adverse outcomes/events impacting members receiving services through an Optum product such as solid organ transplantation, stem cell transplantation, cellular therapies, VAD, and CHD • Develop medical billing code sets for claims-based product analyses. Provide clinical support to product and network colleagues in claims analyses • Clinical support in development and market launch of new Optum products • Clinical support of CSI survey coordinators during product-specific network status qualification processes, i.e., survey development, provider education, and letter writing 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.
