Director Case Management -West Region Job in Albuquerque, New Mexico US
West Regional Director, Case Management for UnitedHealthcare Community State (Virtual position supporting Arizona, New Mexico, and Hawaii)
Responsibilities:
Collaborate with colleagues on a national and state health plan basis to design, to implement and evaluate standardized clinical programs for the Medicaid Aged, Blind, Disabled/Long Term Care/Complex Care business that fulfill the vision, meet the defined value statements and state requirements.
Leverage existing clinical programs and services within the Public Sector and Commercial Market Groups that will best help meet the Long Term Business clinical model vision and goals to create cost effective, well organized, efficient clinical model execution for newly developed Health plans as well as existing
Drive clinical innovation and creativity within defined boundaries of state Medicaid contracts to achieve cost effective clinical outcomes
Build consensus and adoption of newly designed programs at the Health Plan level.
Define Age, Blind Disabled/Long Term Care/Complex Care clinical program outcomes and metrics then develop monitoring/management oversight systems
Ensure clinical contractual requirements are being executed by local health plan
Provide direct health plan support for health services leadership on hiring, on boarding, training
Participate in Regional President Leadership meetings to provide Complex Care Clinical Updates and support
Develop in conjunction with local health plan clinical leaders and national medical director Healthcare Affordability and Quality Initiatives
Develop and implement tools to help local sights execute newly designed clinical model and programs
Implement new clinical business within defined region, utilizing national model and adapting based on contractual/local market needs
Impact of work is most often at the operational or local business unit or market level.
Develops, translates and executes strategies or functional/operational objectives for National Medicare ICCT team including medical management, financial accountability, customer and Provider satisfaction, quality improvement
Directs others to resolve highly complex or unusual business problems that affect major functions or disciplines.
Drives programs that impact markets of customers and consumers.
Ensures team compliance with all regulatory requirements.
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff.
Work most often impacts a large business unit, or multiple markets/sites.
Knowledge and Experience:
Medicare, Tricare, or Medicaid program experience is required
5 + years in Managed care case management or program experience required
Medicaid aged, blind, disabled populations long term care program leadership knowledge and experience preferred.
Bachelor's degree required, Masters in Nursing, Health Administration, Business Preferred.
Must be a licensed registered nurse professional in home state.
Experience with public sector (Medicaid, Medicare or military) program management, clinical process design and implementation.
8+ years clinical practice experience
5+ years working in Medicare health care and insurance industry, including regulatory and compliance requirements
3+ years experience managing needs of aged and disabled
4+ years demonstrated leadership and team development skills
Ability to work in a matrix, fast- paced, evolving work environment.
Ability to work virtual and be flexible to potentially changing priorities
Ability to work autonomously to identify issues, craft action plans, and implement changes to positively impact business function
Ability to promote cross-functional teamwork and fact based decision making
Ability to lead, develop and coach a Medicare ICCT an team
Ability to understand financial modeling and analysis used in making decisions
Ability to track and trend data, identify opportunities for improvement and communicate out effectiveness
Ability to identify training opportunities and deficiencies and work closely with training team
Experience with identification of operational efficiencies to enhance operations, reduce operating costs, and standardize best practices across the organization
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Must be articulate and have excellent verbal and written communication skills in a wide variety of audiences
Ability to lead and influence a wide variety of clinical and senior business leaders
Must be savvy in business and financial acumen, be able to develop cost-benefit analyses and model staffing for various projects
Must have excellent computer skills - MS Office, Excel, Outlook, Power Point, Project
UnitedHealthcare Community State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.