Manager Appeals and Denials – Remote - Remote Eligible

Requisition Number: 2241153
Job Category: Medical & Clinical Operations
Primary Location: Dallas, TX, US
(Remote considered)

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.

As a team member we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.

We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

The Manager, Appeals and Denials is responsible for the day-to-day management and leadership of their assigned centralized Appeals and Denials operations team. This may include, but is not limited to, Appeals and Denials Coordinators and specialty roles within the department. The Manager participates in the hiring and onboarding of new colleagues and the continued clinical development of all colleagues. This position ensures colleagues understand and adhere to established clinical protocols and regulatory processes. This position may work with internal and external partners, local leadership, and other centralized operational teams to deliver efficient compliant processes that result in a positive member and provider experience

Schedule :  Monday – Friday 10am – 7pm CST.  Requires 4 Holidays per year to be worked on a rotating basis.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. A preference will be given to candidates who reside in Pacific, Mountain or Central time zones.

Primary Responsibilities:

• Handle day to day management of Appeals and Denials Coordinators and specialty teams as assigned
• Monitor colleague caseloads daily and recommend adjustments in assignments as needed
• Approve PTO requests ensuring adequate staffing is available to meet the needs of the department
• Monitor, manage, and report productivity at team and colleague level
• Cultivate a solid internal culture designed around collaboration, feedback, motivation, and accountability
• Conduct annual and semi-annual colleague performance reviews
• Ensure the successful onboarding of all new colleagues by completing the 90- day competency review in accordance with all procedures. Report barriers to Director and arrange for ongoing support as identified
• Ensure all required home office inspections are completed annually
• May function as a preceptor and/or mentor or collaborate closely with individual colleagues until they are able to function independently
• Review and report key metrics with Market Leadership as indicated
• Participate in MMR reviews and provide support/coaching/training to improve performance for colleagues scoring below target and participate in process improvement
• Identify and implement process improvements in collaboration with SCM to improve effectiveness and efficiency of team workflows
• Conduct weekly team meetings and facilitate regular weekly/bi-weekly 1:1 meetings with assigned colleagues performing both clinical record reviews and offering guidance/support on challenging cases
• Observe colleague performance via observations at set intervals, but no less than quarterly
• Participate in special projects as assigned by Director
• Ensure compliance with all federal and state regulations, accreditation organizations and client requests
• Perform other duties and responsibilities as required, assigned, or requested

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.

Required Qualifications:

• Active, unrestricted registered clinical license required in your state of residence – Registered Nurse, Physical Therapist, Speech Therapist or Occupational Therapist
• 3+ years of clinical management experience
• Experience managing multi-disciplinary care teams, including nurses, therapists, social workers, case managers
• Proficient with Microsoft Office applications including Word, Excel and PowerPoint
• Proven exceptional interpersonal and communication skills
• Proven solid problem solving and conflict resolution skills
• Proven independent problem identification/resolution and decision-making skills
• Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
• Willing or ability to work schedule listed:  Monday – Friday 10am-7pm CST
• Ability to work 4 holidays per year on a rotating basis

Preferred Qualifications:

• Experience with Medicare Advantage Authorizations, Denials, and Appeals
• Proven knowledge of InterQual and Milliman
• Proven knowledge of NCQA standards and CMS guidelines
• Reside in the Pacific, Mountain or Central Time zones

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.