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Manager, Medical Clinical Operations Southwestern PA or DE more...
Location:Pittsburgh (Univ Of Pittsburgh), PA
Company:Optum Operations
First posted:May 04, 2017

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 and help people live healthier lives while doing your life's best work.(sm) This position has responsibility for oversight of all Care Management (CM) Operations including management of staff, compliance with regulatory audits, management of state based initiatives, adherence to NCQA / HEDIS measures and all administrative services to assure the ongoing work of Optum CM.

This is a work at home position with field - based travel required throughout the state of Pennsylvania or Delaware.

Primary Responsibilities:

Manages and is accountable for professional employees and / or supervisors
Sets team direction, resolves problems and provides guidance to members of own team
Participates in supervised field visits with the Community Health Workers
Adapts departmental plans and priorities to address business and operational challenges
Influences or provides input to forecasting and planning activities
Monitors, manages and controls operational and performance metrics in conjunction with established program value targets
Develops solutions to address new, often complex customer requirements that address operational, clinical and customer needs
Ensures audits are conducted timely, standards are met, and successful outcomes are achieved
Reviews operational and performance metrics regularly and drives action plan development and execution
Ensures site remains compliant with all applicable regulatory and accreditation requirements (NCQA and URAC)
Collaborates across Optum and UHG and interacts with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders

Required Qualifications:

2+ years ofCase Management experience
Proficient in Microsoft Word, Excel and PowerPoint
2+ years of demonstrated ability with developing strategic plans, attainable goals, drive performance, and achieve targets
Must reside within the state of PA or DEto participate in supervised visits with direct reports
Preferred Qualifications:

Prior leadership experience
BSNwith unrestricted RN license in the state of PA or DE
MSW with unrestricted LMSW / LCSW license in the state ofPA or DE
Masters Degree in Healthcare or related field
Experience with data analysis
Experience with training and coaching
Field based or Community based experience
Prior supervisory or management experience (including performance management functions i.e. hiring, performance evaluations, corrective action plans, etc.)
Experience working for an insurance company or other managed care setting
Experience working with the Medicaid and Medicare population
Certified Case Manager (CCM)
Experience with accreditation requirements (NCQA and URAC)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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.

Job Keywords: RN, registered nurse, home health, case management, Pennsylvania, PA, DE, Delaware, Pittsburg, Social Worker, Telecommute, Telecommuter, Telecommuting, Remote, WFH, LMSW/ LCSW

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