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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Position in this function is responsible for all supervisory activities on all aspect of quality assurance within the Clinical RN/Clinical Admin Coordinator or Customer Service roles supporting clinical operations.

Primary Responsibilities:

• Sets priorities for the team to ensure task completions
• Coordinates quality audit work activities with other supervisors
• Identifies and resolves quality operations problems using defined processes, RCA methods
• Conducts business review and provide updates to operations in relation to findings related to quality
• Identifies and resolves operational problems using defined processes, expertise and judgment
• Decisions are guided by policies, procedures, and business plan
• Conducts coaching sessions and regular feedback to team members on highlights and opportunities of performance
• Ensures that there is regular PKT session within auditors, calibration session within the team members and operations
• Identify opportunities for process improvement through problem solving methodologies
• Replicate best practices across teams and drive implementation related to quality audits
• Identify solutions to non-standard requests or problems
• Act as a resource for others with less experience
• Responsible for development and/or ongoing management and administration of quality programs
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Undergraduate degree or equivalent experience
• At least 1 year experience in managerial or supervisor role or similar task
• Proficient in Microsoft Office specifically excel
• Have some knowledge on Root Cause Analysis, Creating Action Plans and Coaching
• Ability to work on multiple tasks and independently
• Desire to Learn and Open to Challenges
• Demonstrate knowledge of healthcare insurance industry and products
• Proficiency in interpreting reports and analyzing data for quality improvement
• For nursing role, must have knowledge and proficiency in using clinical guidelines applicable to review documentation and analysis

Preferred Qualification:

• Solid experience in QA Audit

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.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. 

Optum is a drug-free workplace. © 2023 Optum Global Solutions (Philippines) Inc. All rights reserved.