Teams at Optum

Leads a distributed clinical and non-clinical training and quality team supporting utilization management operations. Oversees onboarding, continuing education, quality assurance, audit dashboards, learning platforms, content management, and process improvement across physician advisor, peer-to-peer review, denials, and appeals workflows. Partners with clinical and operational stakeholders to maintain medical necessity standards, improve performance, and support more than 500 clients and approximately 400 employees.

Manages provider group and financial pool performance for a health plan market. Analyzes financial, utilization, quality, HEDIS/STAR, revenue, and risk data; develops improvement strategies and action plans; produces operational reports; and drives process and technology improvements. Builds relationships with providers, office staff, health plan teams, and clinical stakeholders while resolving issues, supporting claims and member services, facilitating strategic meetings, and improving Medicare Advantage outcomes.

Supervises and coordinates home health clinical services, assigns clinicians, evaluates referrals and care plans, verifies patient eligibility and insurance approvals, and ensures individualized care complies with physician orders and regulations.