Director Remote Utilization Review Jobs in Texas

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
Provides leadership and operational oversight for all non-clinical Utilization Management support services including authorization intake, utilization representatives, provider inquiries, work queue management, administrative correspondence, delegation support activities, operational reporting, and workflow management. Oversees supervisors and administrative staff while ensuring timely, accurate, compliant, and efficient operational support for Utilization Management services.
Provides leadership for operational reporting, universe review, data validation, workflow optimization, quality monitoring, delegation support, and operational analytics. Continuously evaluates administrative workflows, staffing performance, operational metrics, work queues, and reporting trends to proactively identify operational risks, inefficiencies, and opportunities for improvement while implementing sustainable solutions that enhance departmental performance and reduce turnaround times.
Partners collaboratively with clinical leadership, operational leadership, Information Technology, Quality, Regulatory Affairs, and delegated health plans to improve administrative efficiency, strengthen compliance, support audit readiness, and deliver exceptional provider and member service.
If you are located in Pearland, TX, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

• Performance
  • 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
  • Compliance & Internal Quality
  • 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
• Timelines
  • 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
• Other
  • 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

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:

• 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

Preferred Qualifications:

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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 $72,800 - $130,000 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.