RN Manager Delegation Management UM Programs San Antonio Texas
Company: Optum
Location: Floresville
Posted on: June 3, 2025
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Job Description:
Opportunities at WellMed, part of the Optum family of
businesses. We believe all patients are entitled to the highest
level of medical care. Here, you will join a team who shares your
passion for helping people achieve better health. With
opportunities for physicians, clinical staff and non-patient-facing
roles, you can make a difference with us as you discover the
meaning behind Caring. Connecting. Growing together.------
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The Regulatory Adherence Manager for the UM Program is responsible
for planning, organizing, and directing the assigned regulatory
operations for the delegated functions of Utilization Management.
-The Manager coordinates duties with appropriate personnel to meet
operational program needs, ensures compliance with state and
federal health plan requirements, Medicare guidelines and
CMS/URAC/NCQA standards; develops and implements policy and
procedures; updates and integrates current clinical practice
guidelines; performs employee counseling, performance appraisals,
and oversights employee training and development. -The success of
this position requires the ability to foster communication and
teamwork between market care management team, utilization
management staff, and department leadership. -
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Primary Responsibilities:
Supervises and coordinates the work activities of the team for all
delegated functions in an efficient and effective manner utilizing
time management skills to facilitate the total work process
Monitors audit productivity, processes, and communicates results to
department leader
Provides constructive information to minimize problems and increase
customer satisfaction
Spends time mentoring team members, and provide educational needs
as applicable
Provides effective problem solving, works as a UM program liaison
and resource with all customers internal and external to provide
optimal customer satisfaction
Maintains current knowledge of health plan benefits and provider
network including inclusions and exclusions in contract terms
Participates in enterprise activities for execution, monitoring and
quality improvement of all care management clinical programs and
delegated functions
Participates in the development, planning, and execution of
continual process improvement efforts, policies and procedures, and
regulatory compliance functions related to care management
activities
Coordinates all activities related to delegated and regulatory
requirements
Develops initiatives for process improvement of programs
Develops new policies, procedures, job aids, and work flows that
enhance operating efficiency of the regulatory UM program or
activities
Evaluates the success of process improvement efforts and implements
solutions for growth opportunities
Performs all other related duties as assigned
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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:
Registered Nurse with current license in Texas, with compact
license for other participating states
3+ years of experience within a healthcare environment including
experience within a managed care setting, including a minimum of 3
years of management experience
Proven capability to work with people at all levels in an
organization
Excellent training and presentation skills with solid communication
capabilities and practices, both oral and written
Demonstrated effective organizational skills
Excellent communication, writing, proofreading and grammar
skills
Solid attention to detail and accuracy, excellent evaluative and
analytical skills
Solid teamwork, interpersonal, verbal, written, and administrative
skills
Advanced experience using Microsoft office applications, including
but not limited to databases, word-processing, spreadsheets, and
graphical displays
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Preferred Qualifications:
BSN degree
3+ years of utilization management experience
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Physical & Mental Requirements:
Ability to lift up to 25 pounds
Ability to sit for extended periods of time
Ability to use fine motor skills to operate office equipment and/or
machinery
Ability to receive and comprehend instructions verbally and/or in
writing
Ability to use logical reasoning for simple and complex problem
solving
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The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
al minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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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.
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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.
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: Optum, Round Rock , RN Manager Delegation Management UM Programs San Antonio Texas, Healthcare , Floresville, Texas
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