For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.WellMed provides concierge – level medical care and service for seniors, delivered by physicians and clinic stat that understands and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.The Manager of Case Management is responsible for facilitating communication and directing the operations of all Case Management programs in a defined market. The Manager leads the market staff on all activities related to medical management initiatives including changes in process, staffing or care delivery model.Additionally, the manager ensures compliance with all state / federal regulations and NCQA / URAC standards. The Manager collaborates with the Regional Director of Case Management, medical directors, PCPs, clinic and corporate medical management leadership on care coordination activities.Primary Responsibilities:
Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS
Engages in Care Team forums / meetings to support care coordination activities between the market providers and the case management team
Plans, organizes and oversees staff to ensure timely completion of um determinations, discharge planning and case management assessments
Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
Adapts departmental plans and priorities to address business and operational challenges
Oversees the team’s daily staffing requirements to meet program standards
Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
Tracks and trends outcomes for potential improvements in the care management process. Creates monitors, evaluates and disseminates program and productivity reports weekly, monthly, and as needed
Interviews, hires, and retains staff to meet the needs of the department
Evaluates staff performance and recommend merit increases, promotions, and disciplinary actions
Attends, and assists with the facilitation of local market intra-disciplinary care team meetings
Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
Monitors appropriate utilization of resources, overtime, supplies and mileage
Perform comprehensive assessments and document findings in a concise / comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
Performs all other related duties as assigned
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 of Science in Nursing (BSN) (Four additional years of experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
Current unrestricted RN license in the applicable state
CCM certification or proof that certification has been obtained within one year of hire date
5+ years of healthcare experience to include experience in a managed care setting, hospital setting and / or physician practice setting
3+ years of demonstrated supervisory or management experience with responsibility for team performance management
Solid experience with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
Ability to travel in and / or out-of-town as deemed necessary by business need
Preferred Qualifications:
Master of Science in Nursing
Multi-site regional operations management responsibility
Proven solid organizational skills and multitasking abilities
Proven ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
Proven data mining, analytical and reporting skills. Must be able to review and interpret data to make recommendations to senior-management
At 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: OptumCare 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.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.