USRN Supervisor - Clinical Claim Review

Caring. Connecting. Growing Together

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.

Primary Responsibilities

• Manage daily team operations such as attendance, production, inventory etc.
• Provides feedback and coaching to frontline staff on performance and behavior-related observations
• Serves as subject matter expert for any case related queries requiring resolution
• Sets team direction, resolves issues and provides guidance to team members on cases
• Responsible for performance monitoring and completion of annual common review evaluations
• Escalates concerns or operational issues to the proper channel
• Performs quality audit on selected cases to ensure alignment and calibration to process and quality parameters
• Prepares business review updates, prepare and monitor reports related to business metrics such as member enrollments, quality and health improvement results
• Identify opportunity for automation and process improvements in coordination with Operations Excellence
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications

• Active USRN License in a Mainland State
• 2+ years of clinical experience
• With experience in People Management or Supervisory Experience
• Proficient in Verbal and Written Communication
• Knowledge on basic MS Applications: Excel, PPT, Word
• Should be data driven because it will deal with understanding reports and analytics