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Hours Full-time, Part-time
Location Dallas, TX
Dallas, Texas

About this job

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.

Job Summary
The Director of Care Management is responsible for planning, organizing, and directing the assigned regional operations for Care Management services.  The Director coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines and URAC/NCQA standards; develops and implements policy and procedures; updates and integrates current clinical practice guidelines; performs employee counseling, performance appraisals, and oversights employee training and development. 

 

The success of this position requires the ability to foster communication and teamwork between physicians, market care management team, utilization management staff, corporate departments, vendors, and senior leadership.  This position is responsible for oversight and evaluation of all Care Management programs.  The Director will assist senior leadership with long-term planning initiatives to maintain operations assuring activities are appropriately integrated into strategic direction, as well as the mission and values of the company. 

 

Essential Job Functions

1.       Participates, provides input, and impacts outcomes of the following:

a.       Medical Management Committee

b.      Market Success Meetings/ Best Year Yet

c.       Care Coordination Steering Committee

d.      Market Patient Care Coordination Meetings

e.       Tier I Provider Market Meetings

 

2.      Responsible for planning and implementing assigned market and regional market success initiatives with each market care management and operations team to include

a.       Overall Health Care Cost PMPM

b.      Quality of Care Metrics

c.        Acute patient care episodes through Admits/k, Readmits %, ER visits/

 

3.      Directs, plans, and supervises activities for assigned team/region in an efficient and effective manner utilizing time management skills to facilitate the total work process.



    1. Provides constructive information to minimize problems and increase customer satisfaction.

    2. Spends time in each assigned market mentoring team members, fostering relationship with market operations team, and providing resources for vendor and provider education needs.

4.      Provides effective problem solving, works as a care management liaison and resource with all customers internal and external to provide optimal customer satisfaction.  




    1. Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms.

    2. Guides physicians in their awareness of preferred contracts and providers and facilities.

5.       Participates in the development, planning, and execution of continual process improvement efforts, policies and procedures, and regulatory compliance functions related to care management activities.




    1. Coordinates all activities related to delegated and regulatory requirements

    2. Develops initiatives for process improvement of care management programs.

    3. Develops new policies, procedures, job aids, and work flows that enhance operating efficiency of the care management programs or activities.

    4. Evaluates the success of process improvement efforts and implements solutions for growth opportunities

 


6.        Evaluates care management staff performance by providing monthly management level and role level report cards


 


7.        Provides coaching for performance success, recommends merit increases, and consistency executes disciplinary actions.


 


8.        Interviews, hires, and retains quality licensed staff to meet business needs.


 


9.        Ensures the timely preparation of reports and records for dissemination to stakeholders to include:




    1. Monthly Market Metrics

    2. Market Pilot Outcomes

    3. Market Success Initiative Key Outcomes and Milestones

    4. Monthly Team Member Report Cards

10.     Completes and manages regional budget effectively 


 


11.     Conducts and/or participates in departmental meetings, patient care coordination meetings, and interdisciplinary team meetings as required for care management activities.


 


12.     Conducts annual evaluation of regional care management program.


 


13.     Performs all other related duties as assigned.

Requirements


Minimum Required Education, Experience & Skills

-  Registered Nurse with current license in Texas, or other participating states.

-  Bachelor of Science degree, in Nursing, Management, Business Administration or related field required (or eight years of experience in the managed care, disease management, or utilization management field). 

-  Eight or more years of experience in managed care and/or disease/utilization management with a minimum of three years at the management level or above.

-  Case Management Certification (CCM) or ability to obtain within eighteen months of hire.

-  Knowledge of federal and state laws and URAC/NCQA regulations relating to managed care, disease management, utilization management, transition planning and complex care case management.

-  Knowledge of basic principles and practices of clinical nursing.

-  Knowledge of referral processes, claims, case management, and contracting and physician practices.

-  Knowledge of fiscal management and human resource management techniques.

-  Ability to effectively plan programs and evaluate accomplishments.

-  Ability to present facts/recommendations in oral and written form.

-  Ability to analyze facts and exercise sound judgment arriving at proper conclusions.

-  Ability to plan, supervise and review the work of professional and support staff.

-  Ability to apply policies and principles to solve everyday problems and deal with a variety of situations.

-  Ability to exercise initiative, problem-solving, decision-making.

-  Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public.

-  Effective written and verbal communication skills.

-  Proficient with computer software programs, to include: word processing, spreadsheets graphics and databases.

-  In and/or out-of-town travel is required.

 

Preferred Education, Experience & Skills


-  Master's degree preferred.

-  Ten or more years of experience in managed care and/or disease management with a minimum of five years at a management level.

-  Three or more years of experience working in a call center environment.

-  Prior multi-site regional operations management responsibility preferred.

 

 


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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 doyour life's best work.




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.

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