Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group, through Kelsey-Seybold Clinic and Optum, is a leading health care organization focused on coordinated and accountable care. The Manager, Utilization Operations provides leadership and operational oversight for non-clinical Utilization Management support services, including authorization intake, work queues, reporting, compliance, workflow optimization, and staff development. The role partners with clinical, operational, technology, quality, regulatory, and delegated health plan teams to improve efficiency, compliance, audit readiness, and provider and member service.
Responsibilities
- Oversees daily administrative Utilization Management operations
- Supervises Utilization Operations Supervisors and Utilization Management Representatives
- Oversees authorization intake, provider inquiries, work queues, correspondence, administrative support, and operational workflow management
- Reviews operational reporting, universes, productivity metrics, work queue aging, staffing trends, and operational dashboards to proactively identify improvement opportunities
- Implements workflow redesign, automation, and operational improvements that increase efficiency while reducing manual effort
- Develops staff through coaching, performance management, and leadership development
- Serves as primary operational escalation point for administrative issues
- Ensures compliance with CMS, delegated health plan requirements, internal policies, and operational procedures
- Reviews operational universes, delegation evidence, audit documentation, and reporting accuracy
- Identifies operational trends and develops corrective action plans before issues require escalation
- Oversees quality monitoring, documentation accuracy, and operational consistency
- Supports audit readiness and delegation oversight activities
- Ensures administrative work queues meet established internal turnaround time expectations
- Responds to provider inquiries, delegation requests, operational investigations, and administrative escalations with same-business-day acknowledgement and timely resolution
- Monitors staffing capacity and work queue aging to prevent delays
- Coordinates timely completion of reporting, operational deliverables, and administrative requests
- Supports implementation of new technologies, workflows, operational initiatives, and reporting enhancements
- Participates in committee meetings, cross-functional workgroups, and organizational initiatives
- Develops staff through onboarding, mentoring, education, and coaching
- Performs additional duties as assigned by the Senior Manager, Utilization Management
Skills
- Bachelor's Degree
- 5+ years of supervisory or management experience in healthcare operations environment or related field
- Managed Care experience
- Experience supervising administrative healthcare teams
- Experience in workforce management
- Experience in operational reporting
- Experience in process improvement
- Experience in Microsoft Office Suite
- Proven solid written and verbal communication
- Proven solid organizational and analytical skills
- Proven excellent interpersonal and leadership skills
- Demonstrated ability to manage multiple priorities simultaneously
- Master's degree
- Lean Six Sigma Green Belt
- PMP Certification
- Medicare Advantage experience
- Delegation Oversight experience
- Experience in audit preparation
- Experience in regulatory reporting
- Experience in project management
- Experience with Epic
- Experience with Power BI
- Experience in Business Intelligence reporting
- Experience implementing workflow redesign and automation initiatives
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Remote work flexibility for employees located in Pearland, TX, subject to UnitedHealth Group's Telecommuter Policy
Company Overview