Clinical Program Manager, Utilization Management - Remote

UnitedHealth Group•Tampa, FL

13h•$91,700 - $163,700•Remote

About The Position

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.

Requirements

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

Nice To Haves

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

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