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in Philadelphia, PA

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Hours Full-time, Part-time
Location Philadelphia, PA
Philadelphia, Pennsylvania

About this job

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. You'll help improve the health of millions. And you'll do your life's best work.(sm)


 


The RVP, Care Management is responsible for overall management of regional clinical operations, including Care Management, some associated functions (varies by locations) and overall execution of the Utilization Management Program. Responsible for adhering to quality of care, ethical standards or protocols, and overall excellence of service delivered to UBH members served by the site. Responsible for developing and managing within operating budgets. Collaborates effectively with shared services to achieve operating goals. Responsible for quality, productivity, retention and development of staff. The RVP acts as representative of clinical operations as appropriate with new business, sales and account management in sales activities.


 




  • Provides oversight of, and the effective and efficient running of, the Care Advocacy Center (CAC) and all of its activities, particularly those related to Utilization Management.


  • Responsible for leading activities to implement ‘best practices' within the CAC, as well as accountability for ongoing adherence to the best practices.


  • Responsible for driving recovery and resiliency principles into CAC operations¸ translating these into meaningful processes and offerings for consumers.


  • Hire, manage and retain effective leaders and managers to ensure development of a results oriented, team approach to management. This includes providing direction, development and coaching of direct reports as well as overall responsibility for quality, productivity, retention and development of all staff.


  • Accountable for uniform and consistent application of functional area processes / workflows cross the CAC and books of business, as well as effective implementation and management of alternate workflows where required by contract or state regulation.


  • Ensures strong results on Vital Signs survey-particularly Employee Engagement and Manager Effectiveness Index


  • Ensures CAC meets regulatory, audit and reporting standards/requirements


  • Accountable for meeting or exceeding effectiveness and efficiency metric goals (operational (e.g., call queue metrics) and utilization management (e.g., modification, admits/1000) established for the designated functional area within the CAC.


  • Accountable for accurate and consistent use of member stratification criteria by the functional area within the CAC.


  • Responsible for informing, consulting on the production of, and using data, reporting, and analytics for successful performance and productivity of the functional area at the staff, site, book of business/account, and CAC level.


  • Responsible for direct supervision and oversight of office-level leadership.


  • Responsible for collaboration with peer functional leaders to ensure effective and efficient interactive workflows and support for the goals / targets of other functional teams, as well as seamless processes for the consumer.


  • Responsible for effective collaboration with Market Leaders and other UM / HCQAI leadership to ensure that UM / HCQAI goals are supported through CAC activity.


  • Responsible for effective partnership with Account Management and Sales leaders to consult to ensure that UM / HCQAI goals are supported through CAC activity.


  • and create solutions for customer needs and ensure delivery on customer commitments within the CAC.


  • Effectively articulates the function of OHBS clinical operations and differentiates our services from the competitors_


  • Responsible for effective collaboration with Information Technology and Knowledge Management leaders to ensure availability of content and effectiveness of tools for CAC staff.


  • Responsible for effective partnership with Network Services leaders to address clinical and operational issues within facilities, as well as identification of network needs and gaps as related to the functional areas within the CAC.


  • Collaborates with National Market leads in the assessment and response to benefit expense and utilization trends.


  • Assists senior leadership in establishing market and customer based strategies of cost control, consumer engagement, and innovation.


  • Responsible for preparing and maintaining operating budgets.


  • Collaborates with national Workforce Management organization in activities of forecasting workload, organizing and maintaining staff schedules, and managing workloads within the CAC.


  • Responsible for national disaster recovery response and queue coverage in the event of critical vendor, system, or facility outages

 
 


 

Requirements


 




  • At least 10 years of management experience in managed behavioral health care with demonstrated competency managing across multiple teams and/or multiple departments and/or multiple offices.


  • Demonstrates strong leadership in clinical and operational areas including hiring,


  • leading, retaining and motivating effective leaders and employees.


  • Demonstrated leadership in the clinical and operational areas.


  • Excellent communication and presentation skills with demonstrated ability to


  • develop strong and influential relationships with customers and potential customers.


  • Strong operational experience including analysis, utilization management,


  • problem solving with a record of achieving operational goals.


  • Knowledge of Good Clinical Practice/ICH Guidelines and other applicable regulatory requirements


  • Graduate degree in Behavioral Health or RN with specialty in psychiatry.


  • Licensed Ph.D. strongly preferred. 

 


 


 


 


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: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.




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.