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Job Details

UnitedHealth Group

Vice President, Utilization Management - El Segundo, CA


Laboratory Management


El Segundo, California, United States

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

The Vice President of Utilization Management (UM)is responsible for establishing the strategic direction and successfully executing all Utilization Management activities for Optum CA. This person is responsible for planning, organizing, and directing the administration of all regulatory, delegated, and strategic utilization management programs. The VP provides oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company. The position will be accountable for continuous process optimization and will provide support and leadership in the integration of Optum’s UM teams. The VP of Utilization Management will be an important part of the Optum CA Clinical Performance leadership team and work directly with Optum central and regional operations leaders, physician leadership, contracting, finance, UM Medical Directors, Care Management, Claims and Compliance leadership to ensure compliant and high-performing UM process and outcomes. This position will also interface regularly with Optum’s Market and Provider Relations leadership teams to ensure excellent member and provider experience of care across Optum.

The VP maintains organizational structure and oversight of procedures, employment, training, and supervision of all Utilization Management staff. The Vice President coordinates duties with appropriate personnel to meet operational program needs and ensures compliance with state and federal health plan requirements as well as ensuring Optum members receive appropriate access to care and coordinated, evidence-based services. The Vice President is also responsible for cultivating new leadership for the department.

Primary Responsibilities:

  • Leads the integration of Optum CA Utilization Management and serves as an innovative thought leader in the expansion of utilization management programs to support quality, affordability initiatives, network optimization, and compliance to better serve Optum members
  • Development, implementation and oversight of people, processes and technology required to execute Optum California’s utilization management program
  • Actively collaborates with internal stakeholders and external partners, payers, and regulatory agencies to transform the health care experience for Optum customers and members
  • Develop and lead efforts to achieve financial performance consistent with division and market goals
  • Oversees and ensures Utilization Management compliance and adherence to all state and federal regulations, contractual agreements, and other applicable accreditation standards. In addition, ensures adherence to other UM/CM/DM delegated agreement standards and expectations for all contracted health plans
  • Create the culture, systems, and processes that support consistent audit-readiness. Ensures internal audits are conducted, reviews results, formulates and implements appropriate action plans to correct any areas of noncompliance. Develop and oversee implementation of Corrective Action Plans as needed
  • Encourages Utilization Management staff to develop skills and knowledge for personal growth and promotion of position. Fosters leadership skills for supervisor positions to ensure qualified staff performs management of processes. Promotes appropriateness in the utilization of staff by being flexible and assisting others when a staffing problem occurs. Identifies and helps develop future leaders
  • Actively participate as a key member of the Clinical Services Sr. Leadership team and in the development of policies, programs and initiatives that improve Employee Engagement, Diversity & Inclusion and Drive our Health Equity Goals

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
  • 7+ years of experience in managed care and/or utilization management with 10+ years of management level experience
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualification:

  • Master’s degree

Professional Competencies:

  • Solid clinical leadership skills to ensure trust and respect of clinical staff
  • Solid operational mindset and ability to use data to draw insights
  • Solid ability to communicate in written and verbal presentations
  • Solid relationship development and team management skills
  • Results oriented, capable of clearly translating strategic objectives into implementation plans that drive outcomes
  • Success in driving organizational change and performance improvement
  • Solid collaboration skills to ensure effective alignment among diverse teams
  • Ability to excel in a matrixed environment

Work Environment:
The majority of work responsibilities are performed remotely or in an office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel will be required

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action 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.

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