In this leadership role, you will oversee a critical training and quality organization supporting utilization management operations across a large, geographically dispersed healthcare environment. Leading a team of approximately 12 clinical and non-clinical professionals across onshore and global locations (including the U.S., Manila, and Puerto Rico), you will be accountable for onboarding, ongoing education, quality assurance, content management, and process improvement supporting over 500 commercial and enterprise clients nationwide. Leveraging platforms such as EQT and Thought Industries, you will serve as a strategic operational leader driving quality standards and clinical education across utilization management, physician advisor functions, peer-to-peer review support, and appeals operations.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:- Lead and develop a multidisciplinary team of approximately 12 clinical and non-clinical training and quality auditor professionals across onshore and global locations
- Support ongoing education including cross training education efforts across the existing ~400 FTEs in the Optum Physician Advisor & Utilization management team
- Direct the end-to-end design, development, enhancement, and delivery of training programs for new hire onboarding and ongoing operational education
- Establish and oversee quality assurance processes, performance metrics, and audit dashboards across clinical and non-clinical utilization management workflows
- Align training and quality initiatives with medical necessity guidelines, denial management protocols, physician advisor activities, and peer-to-peer review processes
- Partner with stakeholders across physician, nursing, and operational teams to drive continuous quality improvement and address clinical knowledge gaps
- Oversee learning platforms and dashboard technologies (e.g., EQT tool, Thought Industries platform) to maintain high-quality learning content and track performance indicators
- Manage global, multi-site operational standards across distributed teams to ensure high quality and client satisfaction across 500+ commercial and enterprise clients
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:- 5+ years of people leadership experience managing clinical and non-clinical teams within a healthcare environment
- 3+ years of experience leading training program development, quality assurance operations, or organizational education
- 3+ years of experience in utilization management operations or utilization review environments
- 3+ years of working knowledge of medical necessity criteria such as InterQual and MCG, physician advisor workflows and both concurrent and retrospective denials management.
- 2+ years of experience leading or managing globally distributed or multi-site teams
Preferred Qualifications:- Active M.D., D.O., RN clinical credential/licensure
- Training experience at a management level
- Demonstrated experience serving as a clinical peer, mentor, or leader across multidisciplinary teams (physicians, nurses, and non-clinical staff)
- Experience within a healthcare payer organization or large, complex health system with comparable scale
- Direct experience supporting physician advisor operations, utilization review and denials management workflows
- Hands-on experience with EQT dashboards or the Thought Industries training platform
*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 $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
