Director of Clinical Training & Utilization Management

Optum

Charlotte (NC)

Remote

USD 135,000 - 231,000

Full time

8 days ago

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Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Remote work flexibility

Job summary

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.

Qualifications

5 years of people leadership experience managing clinical and non-clinical teams within a healthcare environment.
3 years of experience leading training program development, quality assurance operations, or organizational education.
3 years of experience in utilization management operations or utilization review environments.
3 years of working knowledge of medical necessity criteria such as InterQual and MCG, physician advisor workflows and both concurrent and retrospective denials management.
2 years of experience leading or managing globally distributed or multi-site teams.

Responsibilities

Lead 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.