Remote Utilization Review Manager Jobs in Puerto Rico

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.

In this role, you will work directly with providers to review medical necessity for Applied Behavior Analysis (ABA) requests and provide Autism education and resources to parents and caregivers. This is a telephonic, queue-based position with a structured schedule between the business hours of 7am - 7pm CST, Monday - Friday.

** Florida residency and licensure are required. **

If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Review comprehensive diagnostic evaluations to ensure valid diagnosis has been given
• Obtain clinical information from providers on Applied Behavior Analysis requests for treatment
• Determine if additional clinical treatment sessions for Applied Behavior Analysis are medically necessary in accordance with appropriate level of care guidelines
• Manage outpatient cases throughout the entire treatment plan
• Coordinate benefits and transitions between various areas of care including case management
• Identify ways to add value to treatment plans and consult with facility staff or outpatient care providers on those ideas
• Provide education and resources to parents/caregivers specific to Applied Behavior Analysis treatment and/or their benefit plan
• Quote benefits and provide referrals as needed

You'll find the pace fast and the challenges ongoing. We'll expect you to achieve and document measurable results. You'll also need to think and act quickly while working with a diverse member population.

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:

• Active, unrestricted, independent clinical license in Florida: LCSW, LMFT, LMHC, or LP
• 2 years of post-licensure experience in a related mental health environment
• Experience working with children and/or adolescents with Autism
• Proficient in Windows and Microsoft, including MS Word, Outlook, and Teams
• Proven ability to talk the phone and type simultaneously while toggling between multiple screens / programs
• Dedicated, distraction-free workspace and access to secure, high-speed internet at home 
• Reside in Florida

Preferred Qualifications:

• Board Certified Behavior Analyst (BCBA)
• Experience working at a Managed Care Organization or health insurance company
• Utilization Management or Utilization Review experience
• Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients

*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 $60,200 - $107,400 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.  

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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.