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Manager of Utilization Management, RN or LVN - AppleCare Medical - La Palma, CA

UnitedHealth Group

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739423 Manager of Utilization Management RN or LVN AppleCare Medical La Palma CA

Manager of Utilization Management, RN or LVN - AppleCare Medical - La Palma, CA (739423)

Position Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.



As a part of our continued growth, we are searching for a new Manager of Utilization Management to join our team.


The Manager of Utilization Management is responsible for the direction, oversight and facilitation of the Outpatient Utilization Management process including referral management, special UM programs, and episodic care coordination. This position is also responsible for the facilitation & promotion of UM projects which may include health plan ACO contract UM activities.     


Primary Responsibilities:

  • Provides leadership and direction to Utilization Management staff

  • Performs personnel counseling and develops & implements performance improvement plans

  • Identifies outpatient clinical efficiencies and assists the Vice President of Clinical Services in the development and implementation of UM programs

  • Works collaboratively with Inpatient Management, Case Management, and Quality Management leadership

  • Identifies high dollar / high risk cases

  • Provides senior management with analysis of inpatient utilization reports

  • Assists in the development and implementation of clinical service staff and provider training programs

  • Participates in various meetings including PCP / Provider Office Meetings, health plan JOMs, and hospital JOCs

  • Other duties as assigned

Required Qualifications:

  • Current LVN license in the state of California
  • 2 or more years of Supervisory / Management experience
  • 2 or more years of  Utilization Management experience
  • Excellent written and verbal communication skills
  • Computer proficiency in MS Office: Outlook, Word, Excel, PowerPoint



Preferred Qualifications:

  • Current RN license in the state of California
  • Management experience in an IPA or group health plan model


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.




Job Keywords: Manager, Managed care, Utilization Management, UM, Case Management, RN, LVN, La Palma, CA

Job Details

  • Contest Number739423
  • Job TitleManager of Utilization Management, RN or LVN - AppleCare Medical - La Palma, CA
  • Job FamilyNursing
  • Business SegmentOptumCare

Job Location Information

    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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