Associate Director - Remote

UnitedHealth Group•Hartford, CT

4d•$112,700 - $193,200•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Assistant Director provides clinical expertise, claim risk assessment, cost containment support, and leadership for the Medical Management team. This role supports underwriters, claims auditors, vendor partners, brokers, administrators, and internal teams by evaluating high-risk claimants, estimating cost of care, identifying cost containment opportunities, and serving as a clinical resource across the organization. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Current and unrestricted RN license in the state of residence
5+ years of clinical experience
4+ years of experience working in the Stop Loss industry, TPA’s or managed care company
2+ years of ER, critical care or oncology experience
Managerial experience
Proficient in Microsoft Excel
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Training experience
Demonstrated ability to multitask and remain organized

Responsibilities

Review and assess large claim notices for potential risk within 48 business hours of receipt
Set up potential high-dollar claimants in POWER for ongoing risk assessment and reserve allocation
Monitor claimants monthly or biweekly, based on severity and changes in treatment
Apply clinical and cost knowledge to determine when claimants should be established for ongoing monitoring
Notify the underwriter and claims auditor when potential risk is first identified and provide updates as risk changes
Educate non-medical internal and external customers on clinical trends, treatments, and possible outcomes
Research medical conditions and disease states to support appropriate treatment understanding for specific conditions
Use reputable clinical resources, such as NCCN, CDC, Predict Dx/Rx, and Profiler, as needed
Assess all claimants for potential cost containment opportunities
Collaborate with TPAs, case managers, claims auditors, underwriters, and vendors to identify and implement appropriate cost containment measures
Maintain timely diary follow-up for all claimants open in POWER
Index all documentation received
Co-manage complex medical cases with the Transplant/Dialysis Coordinator
Provide clinical claim file review support for claims auditors as needed
Perform appropriate research for each clinical claim file review request
Discuss findings and answer claims auditor questions as needed
Perform experimental and investigational file reviews for Claims
Review PYCS to assist the claims auditor in setting appropriate reserves based on known or anticipated costs
Review all documents indexed into the package for each cost estimator request
Perform appropriate research for each cost estimator request
Identify actual and potential risks for each request
Document a clinical summary and estimate the cost of care for each individual identified as at risk
Re-review additional information and update cost estimates as needed
Complete cost estimate requests for new business within 24 business hours of receipt and renewal business within 48 business hours of receipt
Discuss findings and answer underwriter questions as needed
Complete Hot Claims reports as needed to track large claims and cost containment strategies implemented
Serve as a subject matter expert for the underwriting team and act as the first point of contact for questions, concerns, and education related to clinical responsibilities
Serve as a clinical resource and provide coaching and training to new or less experienced team members
Assist with training and orientation for new employees
Continue researching new treatments and clinical trends and share relevant knowledge with the broader team
Participate in the development of clinical policies for the Medical Management team
Facilitate monthly clinical communication calls on a rotational basis
Perform the monthly LCN quality assurance process for the team and report results to the Director
Participate in cross-functional teams to develop or enhance workflow processes
Identify new processes and changes to existing processes that support company growth and success
Assist in developing consistency for implementation calls with new customers
Continue learning the business aspects of the clinical function to support readiness for future Director-level opportunities
Work with internal and external vendor partners to learn more about cost containment opportunities and explain the team’s role, objectives, and value
Increase regular interaction with administrators and brokers to provide education where needed
Build trust and collaboration with brokers and vendors
Provide coverage for the Director when she is out of the office, ensuring metrics are met by required due dates and workflow remains on track
Begin attending monthly management calls when appropriate