Clinical Program Manager, Utilization Management - Remote

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. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provide leadership and oversight of the Utilization Management (UM) program for higher levels of care, including residential and inpatient treatment for substance use and mental health disorders
• Deliver clinical supervision, coaching, training, performance management, and professional development for Care Advocates and Wellness Coordinators dedicated to the Medica business
• Lead process improvement initiatives and serve as a champion for change management, operational excellence, and project implementation across the Utilization Management team
• Develop, maintain, and enhance policies, procedures, knowledge articles, and team resources, ensuring information remains accurate, current, and user-friendly
• Partner in regulatory audit preparation, support audit activities, and implement corrective action plans as needed to ensure compliance and continuous quality improvement
• Communicate departmental goals and performance expectations clearly, fostering accountability and collaboration to achieve or exceed business objectives
• Ensure adequate staffing and service levels, including oversight of phone coverage and after-hours on-call support
• Monitor utilization, quality, and performance trends to identify opportunities for improvement and drive operational effectiveness
• Conduct clinical case reviews and audits, providing consultation and guidance to staff to ensure appropriate level-of-care determinations and high-quality member outcomes
• Collaborate with internal and external stakeholders on customer-focused initiatives, strategic projects, and new business implementations
• Anticipate customer and business needs, proactively developing solutions that enhance service delivery and operational performance
• Serve as a subject matter expert and resource for complex clinical, operational, and customer issues, developing innovative and effective solutions
• Foster a positive, high-performing team culture by motivating, mentoring, and inspiring team members to achieve individual and organizational success

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

 

Required Qualifications:

• Master's or doctoral degree in Psychology, Social Work, Counseling, or a related behavioral health field
• Current, unrestricted independent clinical license (LP, LPC, LPCC, LMFT, LICSW, or equivalent)
• 5+ years of post-licensure clinical experience in behavioral health, mental health, or substance use treatment settings
• 4+ years of leadership or people management experience
• Solid knowledge of behavioral health levels of care, clinical best practices, and utilization management principles
  
   

Preferred Qualifications:

• Experience leading projects, process improvement initiatives, or organizational change efforts
• Experience working within a managed care, health plan, or payer environment
• Utilization Management experience, including review of higher levels of care for mental health and substance use disorders
• Experience with regulatory compliance, accreditation standards, and audit readiness activities
• Solid analytical skills with the ability to interpret data, identify trends, and drive data-informed decision-making

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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