Remote Utilization Operations Leader

UnitedHealth Group; Pearland (TX); Hybrid; Confidential; Full time

Job summary

Kelsey-Seybold Clinic, part of the Optum family, offers a leadership role overseeing non-clinical Utilization Management support services at our Pearland location. You will oversee authorization intake, provider inquiries, and workflow management while partnering with clinical and IT teams to improve efficiency.

The role emphasizes performance oversight, reporting, and compliance with CMS and delegated plans. Remote work flexibility is available, supporting a challenging, high-impact environment.

Qualifications

• Bachelor's degree required.
• 5+ years of supervisory or management experience in healthcare operations.
• Managed Care experience.
• Experience supervising administrative healthcare teams.
• Experience in workforce management.
• Experience in operational reporting.
• Experience in process improvement.
• Experience in Microsoft Office Suite.
• Strong written and verbal communication.
• Strong organizational and analytical skills.
• Interpersonal and leadership abilities.
• Ability to manage multiple priorities.

Responsibilities

• Oversee daily administrative Utilization Management operations.
• Supervise Utilization Operations Supervisors and Utilization Management Representatives.
• Oversee authorization intake, provider inquiries, work queues, correspondence, administrative support, and workflow management.
• Review operational reporting, universes, productivity metrics, work queue aging, staffing trends, and dashboards to identify improvements.
• Implement workflow redesign, automation, and efficiency improvements.
• Develop staff through coaching, performance management, and leadership development.
• Serve as primary operational escalation for administrative issues.
• Ensure compliance with CMS and health-plan requirements.
• Review universes, delegation evidence, audit documentation, and reporting accuracy.
• Identify operational trends and develop corrective action plans.
• Oversee quality monitoring, documentation accuracy, and consistency.
• Support audit readiness and delegation oversight.

Skills

Supervisory experience

Healthcare operations knowledge

Workforce management

Operational reporting

Process improvement

Communication skills

Analytical skills

Organizational skills

Interpersonal leadership

Education

Bachelor's Degree

Master's degree (preferred)

Tools

Microsoft Office Suite

Power BI

Epic

Job description

Kelsey-Seybold Clinic, part of the Optum family, offers a leadership role overseeing non-clinical Utilization Management support services at our Pearland location. You will oversee authorization intake, provider inquiries, and workflow management while partnering with clinical and IT teams to improve efficiency.

The role emphasizes performance oversight, reporting, and compliance with CMS and delegated plans. Remote work flexibility is available, supporting a challenging, high-impact environment.