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Manager of Utilization Management- RN/LVN- $10,000 SIGN-ON BONUS!- Rancho Cucamonga/Chino, CA

UnitedHealth Group

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Manager of Utilization Management- RN/LVN- $10,000 SIGN-ON BONUS!- Rancho Cucamonga/Chino, CA(Job Number:725320)

Careers at OptumHealth. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen.


North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.


The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.


Primary Responsibilities:

  • Provide innovation and input to improve member care, operational efficiency, and regulatory compliance
  • Facilitate training and cross-training of staff, in conjunction with corporate department, to maximize effectiveness and utilize staff to their fullest potential
  • Maintain department expenditures within budget and work with the ED and group Medical Director to develop the annual department budget
  • Oversee the Utilization Management Committee and ensure adequate representation for UM on all work teams and committees
  • Oversees the application of clinical criteria, performance standards and appropriateness protocols
  • Monitors, evaluates and provides ongoing feedback to staff, in a timely manner, regarding work performance, incorporating performance improvement goals
  • Prepares and/or oversees the Utilization Management Committee agendas in conjunction with the Medical Director and Administrator in accordance to standard policy
  • Maintains minutes and documentation of meetings and teams as assigned
  • Participates in Quality Improvement Committee in conjunction with QI Nurse, QI Chairperson / Medical Director

Job Clinical Utilization Managemen
Primary Location US-CA-RANCHO CUCA
Other Location US-CA-CHINO HILLS, US-CA-Ontario
Organization NAMM California
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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