Manager of Medical & Clinical Operations - New Castle County, DE

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 CM operations including management of staff, compliance with audits, management of state based initiatives, adherence to NCQA/HEDIS measures and all administrative services to assure the ongoing work of Optum CM in Pennsylvania. There will be some field-based travel within the areas of either Philadelphia or Harrisburg (depending on the location of the candidate).

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 


• 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, standards are met, successful outcome are achieved 


• Reviews operational and performance metrics regularly and drives action plan development and execution 


• Ensures site remains compliance with all applicable regulatory and accreditation requirements (NCQA and URAC) 


• Collaborates across OCHS and UHG including Medical, Site Directors, senior leaders, sales, account management, product organization, and other stakeholders
  

Required Qualifications:

• Active, unrestricted RN license in your state of residence 


• 3+ years of clinical experience 


• Proficient in Microsoft Word, Excel and PowerPoint 


• Strong communication skills (both written and verbal) 


• Ability to work in a rapidly changing environment 


• Problem solving skills, detail oriented and highly organized 


• Strong teambuilding, leadership and mentoring skills 


• Demonstrated ability with developing strategic plans, attainable goals, drive performance, and achieve targets 


• Must live within a commutable distance of New Castle County, DE (position will require some field-based travel within region)

Additional Preferred Assets:

• BSN 


• Home health and/or case management experience 


• Previous 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 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: 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.