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in Brentwood, TN

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Hours Full-time, Part-time
Location Brentwood, TN
Brentwood, Tennessee

About this job

Careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work.(sm)  

Primary Responsibilities:


Assist with the implementation and successful execution of the Employment and Community First (EFC) CHOICES program. A new program that will be a component of the CHOICES program that will allow the state to provide HCBS more cost-effectively in order to service more people with intellectual disabilities and begin servicing people with other developmental disabilities

Ensures clinical processes, policies and procedures meet regulatory standards and are consistent with state protocols

Leads, coaches, and develops ECF member advocates and proactively develops and implements staff retention and engagement programs

Assures that patient is actively engaged in health care decisions and assist, to the extent possible, in directing such care

Ensures monitoring and oversight of programs to meet defined goals, targets and regulatory requirements

Works collaboratively with providers, other business segments, service contractors and health plan management to oversee the EFC program with the objectives of improving the quality of care delivered to members, improving cost efficiencies, and developing a patient-centered environment that promotes prevention and protection from harm

Collaborates with internal and external entities to improve accessibility standards and patient-centered care standards

Regularly interacts with Health Plan Senior leaders, State Regulators, Providers and Advocates to promote effective program administration

Advocates for ECF families and assist them in having voice and choice in their health care decisions

Have input into planning, training and delivery of services for individuals with I/DD, program monitoring and evaluation

Serve as primary point for escalation helping to connect caregivers to necessary clinical and community resources

Identifies and engages community supports, including culturally appropriate social service agencies, city and county agencies, religious organizations, and consumer and family support groups

Engages with member services or care coordinators to provide additional support in issue resolution

Makes recommendations to health plan leadership on recommended changes needed to improve the care system

Assures members, caregivers, and case managers are aware of member rights and responsibilities under the IDD program and ensure that Person Centered practices are consistently applied. Educates members and caregivers on their benefits, covered services available to them, and the availability of and access to non-covered, community-based services and resources

Requirements

Required Qualifications:

Bachelor's degree, Master's degree preferred
7+ years' experience in patient-centered care delivery management
Strong knowledge of the local provider population and facilities, and knowledge of community-based organizations (CBOs) to assist with member and provider training needs
Strong knowledge of the care needs/options of persons with intellectual and developmental disabilities
Must be physically located in the state of TN. Greater Nashville area preferred
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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, 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.
 
Keywords: Director, Associate Director, Medical and Clinical Operations, Clinical Management, Tennessee, Brentwood, TN, Nashville