RN Utilization Manager, DSNP Home Care

UnitedHealth Group; Washington (District of Columbia); On-site; Confidential; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase program

401k contribution

Job summary

UnitedHealth Group is seeking an RN Utilization Manager in Washington, DC, to lead HCBS review for the Optum at Home program within the DSNP framework. You will oversee the clinical team, drive care planning, and ensure compliance with medical necessity reviews while collaborating with health plan partners.

The role requires an unrestricted RN license in DC, 3+ years in utilization management, and ability to travel within the DC area. A BSN and CCM certification are preferred.

Qualifications

• Current unrestricted RN license in Washington DC.
• 3+ years of Utilization Management experience focused on medical necessity reviews and team development.
• Proven ability to build internal and external healthcare relationships.
• Proficient documentation in written and electronic medical records.
• Valid Driver's License and reliable transportation for travel within a designated area.

Responsibilities

• Set team direction, resolve problems, and guide team members.
• Lead and develop DSNP clinical team using weekly Grand Rounds for HCBS review and care planning.
• Oversee supervisors and staff in HCBS review topics and staff training sessions.
• Adapt plans to address business and operational challenges.
• Manage policies for authorization, oversight and monitoring of long-term services and supports.
• Contribute to forecasting and planning activities.
• Ensure performance metrics and guarantees through Utilization rounds and care planning.
• Provide orientation and development for clinical staff with HCBS review.
• Use performance tools to hold the team accountable for HCBS processes.
• Grow new membership through active engagement with staff.

Skills

Utilization Management

Data analysis

Team leadership

Healthcare relationships

Documentation in EMR

Education

BSN

Job description

UnitedHealth Group is seeking an RN Utilization Manager in Washington, DC, to lead HCBS review for the Optum at Home program within the DSNP framework. You will oversee the clinical team, drive care planning, and ensure compliance with medical necessity reviews while collaborating with health plan partners.

The role requires an unrestricted RN license in DC, 3+ years in utilization management, and ability to travel within the DC area. A BSN and CCM certification are preferred.