At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.Purpose of Job:To lead a team of case managers, while overseeing day-to-day clinical operations and participating in business development activities. The person in this position will manage a program or region, including performance management, process improvement, and standardized execution of clinical decision processes, case manager team management and implementation of new program initiatives including global and regional medical affairs initiatives. Function also includes problem-solving at the member, family, and provider level.This is a telecommute position but will require travel through Maricopa County, and there will be some travel to the Phoenix office as needed.If you are located in Maricopa County, AZ, you will have the flexibility to telecommute as you take on some tough challenges.Primary Responsibilities:
Excellent Communication skills, possess de-escalation skills and ability to interrelate with individuals at various level and in various functional areas throughout the organization and to develop effective business relationships
Identify, select, structure, and prioritize process improvement projects and revises to meet changing needs and requirements
Follow up with workgroup team members as appropriate
Lead one or more projects across internal and or external divisions or areas
Participates in program development/initiative workgroups within UnitedHealth Group
Manages utilization program as a result of day-to-day management and successful implementation of initiatives
Creates a team-oriented management environment, enhancing the integration between the clinical and operations sections of medical affairs
Manages mentors and supports staff in designated department or region
Engage in regular auditing activities with the ability to provide focused education individually as well as across the team as patterns emerge
Develops clear goals and objectives for performance management and effectively communicate accountability
Assists with design and implementation of global and regional medical affairs initiatives
Assists in strategic development of medical affairs processes to ensure that efficient and systematic operational plans are created and executed
Ensures standardized execution of workflow processes, such as authorizations and non-certifications and analyze outcomes of standardized audits for AHCCCS, NCQA, HEIDIS purposes
Acts as regional interface with other departments to coordinate workflow processes and implementation plans
Assists in the development and execution of educational programs to enhance staff development
Monitors performance metrics specific to functional area. Evaluates metrics in addition to developing action plans to address variance from standards
Oversees team of case management staff, serves as a mentor, monitors adherence to state contract requirements and performance measure outcomes
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:
Registered Nurse with a current AZ license or Degreed Social Worker or who has a degree in psychology, special education, or counseling or degree in similar field
3+ years of case management experience serving elderly and/or persons with physical or developmental disabilities
3+ years of supervisory experience
2+ years case management experience serving members determined to have a Serious Emotional Disability (SED) and/or Serious Mentally Illness (SMI)
Ability to perform in a leadership role, training experience and regularly exercise independent judgment and discretion in handling of duties
Working knowledge of Microsoft Word, Excel, and PowerPoint
Demonstrated solid written / grammar and communication skills, excellent time management skills, the ability to master new skills and ideas, able to adapt to change, and exhibit flexibility
First rate customer service, interpersonal skills, detail oriented and self-motivation
Basic knowledge of Medicare / Medicaid regulations
Exhibit original thinking and creativity in the development of new and improved methods and approaches to problems
Ability to function independently and responsibly with minimal need for supervision
Demonstrate initiative in achieving individual, team, and organizational goals and objectives
Effective team player
Demonstrated solid organizational skills
Ability to travel locally up to 25% to visit members and providers in the community
Live Arizona
Preferred Qualifications:
Long-term care, home health and managed care experience, and care coordination
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyAt 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: 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.
Full-time