Senior Manager Medical Expense Management

Job ID: 99180398752Posted: 2026-08-14Location: Worcester, Massachusetts, United StatesSalary: $91,700 - $163,700/yearJob Area: NursingCompany: UnitedHealth GroupFor 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 to start Caring. Connecting. Growing together.Responsible for coordinating care management activities and clinical program development. Provides coordination of the overall activities of care management department. Leads the development of care management objectives, policies, plans, programs and budgets while maintaining a cost efficient and effective service, supporting the organization's clinical practices.Primary Responsibilities:Oversees Utilization and Referral programs, including acute care, skilled nursing facility and home care, achieving targeted outcomesIntegrates utilization and referral management groups. Organizes to maximize program efficiency and effectiveness. Recruits and oversees team leaders. Oversees evaluation of the clinical performance of the department and staff. Oversees the day-to-day operations of all utilization and referral management programsManages identification of pending high cost casesResponsible for compliance to and meeting all NCQA requirements for delegated case management as well as being responsible for NCQA certification for utilization managementResponsible for the successful implementation of all future, delegation effortsManages expenditures such as utilization: inpatient, SNF, hospital outpatient expenses: ER, facility, home care, ambulance, DME, tertiary referrals and POM with Service Director, regional leadership and others, participate in clinical program development, implementation, business plans, trade-off proposalsManages inpatient and outpatient populations to anticipate needs, optimize outcomes and cost-effective care. Implements and monitors programs focused on proactive outreach for high-risk patientsEnsures quality of department services via ongoing training of staff, case review, internal audits and inter-rater reliability auditsInterfaces and resolves issues with vendors such home health care, hospitals, nursing facilities, etc., to ensure appropriate quality of care and service is delivered to patients. Participates in research activities to establish benchmarks; stay informed about innovative programs that can be replicated at the organizationRecruits and selects members of the utilization and referral management teams to manage the needs of assigned areas of responsibilityDelegates authority and responsibility to members of the teams for the operation and coordination of the programs and servicesWorks with department leaders to minimize outside referrals and resolve identified barriers to careActs as a resource for team members as neededManages the business and fiscal affairs of the department, including the preparation of business plans and annual capital and operating funds budgets. Monitor and assume corrective action for variancesEstablishes positive working relationships with the organization's site staff as well as payer staffs and managementDirects and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hire, transfers, promotions, salary changes, discipline, terminations, and other similar actions. Resolves grievances and other personnel problems within position responsibilitiesDevelops and recommends, in conjunction with manager, the operating and capital budgets for the areas managed. Manages activities to assure financial goals met. Monitors expenditures for compliance to approved budget. Resolves discrepanciesCoordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achievedProvides effective direction, guidance, and leadership over the staff for effective teamwork and motivation, and fosters the effective integration of efforts with clinic-wide initiativesParticipates in performance improvement initiatives and recommends procedural changes when appropriateEnsures compliance with regulatory agencies such as DPH, etc. Develops and maintains procedures necessary to meet regulatory requirementEnsures that assigned area comply with clinic established policies, quality assurance programs, safety, and infection control policies and proceduresEnsures adequate equipment and supplies for assigned areaEnsures compliance to all health and safety regulations and requirementsPerforms similar or related duties as required or directedRegular, reliable and predicable attendance is requiredYou'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:BSNCurrent Massachusetts RN licensure5+ years of relevant experienceProven experience in coordination and management of treatment servicesDemonstrated leadership ability in building teams which have worked to achieve a common goalKnowledge of budget development and management, and collaborative multi-specialty program development and managementKnowledge of Utilization Management and Case ManagementExcellent organizational, communication, and interpersonal skillsKnowledge of a variety software products such Microsoft Outlook, Word, Excel, PowerPoint, etc.Driver's license and access to reliable transportationPhysical Requirements:Physical health sufficient to meet the ergonomic standards and demands of the position 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. 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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.