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UnitedHealth Group RN Manager Case Management OptumCare AZ in Phoenix, Arizona

$5000 Sign On Bonus for External Candidtes

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. OptumCare Arizona is seeking a Manager, Center for Service Coordination who shares our passion for helping others live healthier lives. As one of the world's leading health care companies, OptumCare is pursuing innovative new ways to improve on our ability to deliver high-quality programs and services to our patients wherever they live. Bring your skills and talents to a role where you'll have the opportunity to make an impact.

As a Manager for our Center for Service Coordination department, you will be a key leader in managing a team dedicated to supporting our members. Your primary role will be managing a team of both non-licensed and licensed employees who outreach to our members to ensure all of their healthcare needs are met. Identification and enrollment of the appropriate programs and services available is critical to our success in improving outcomes for our members and helping them live healthier lives.

Primary Responsibilities:

  • Manages a team of non-licensed and licensed (RN) employees dedicated to supporting members with coordinating healthcare services, collaborating with our PCP Network, physician offices and hospital facilities, and performing case management for multiple products and lines of business

  • Responsible for the day-to-day operations of the department, monitoring metrics, performing audits, policy and process development, and program development/implementation

  • Charged with leading the development and ongoing management of operational processes and clinical programs to support Special Needs Plans (SNP) and ensure delegation requirements are met

  • Manage programs to drive improved outcomes and acheiving affordability targets for the following products: Commercial, Medicare and Medicaid

  • Ongoing oversight of processes, monitoring outcomes and quality improvement of the non-licensed team for the following processes:

  • Outreach calls to our members/beneficiaries post facility discharge

  • Arranging post-discharge appointments, transportation, and transition of our members across the continuum of care

  • Making appropriate referrals to the Customer Care team to support benefit, billing / payment and eligibility of our members

  • Assisting with referrals / calls received by the Center for Service Coordination department, and complete community outreach and documentation

  • Administrative functions: case building, uploading clinical documents, mailing resources to members as identified by medical management staff

  • Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members, goals including both short and long term

  • Working with the Utilization Management RNs, Social Worker (LMSWs) Case Managers and other internal and external providers to facilitate smooth care transitions

  • Ongoing oversight of processes, monitoring outcomes and quality improvement of the licensed RN(s) for the following processes:

  • Transitional care management for members transitioning from one level of care to another

  • Telephonic case management services to moderate and high-risk members

  • Has a standardized execution of workflow processes

  • Provides assessments of physical, psycho-social and transition needs

  • Develops interventions and processes to assist Medicare, Medicaid and Commercial patients in meeting short- and long-term plan of care goals

  • Nurse Case Manager works with their supervisor to work their assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process

  • Confers with physician advisors on a regular basis and participates in departmental conferencing and interdisciplinary team meetings

  • Plans patient transitions with internal medical management staff and external providers

  • Enters timely and accurate data into designated case management applications as needed to communicate patient needs

  • Takes major role in setting direction and participating in or developing new programs

  • Sets team direction, resolves problems and provides mentoring and guidance to team members and other staff

  • Ensures team meets established performance metrics, outcomes and defined customer performance guarantees

  • Adapts departmental plans and priorities to address business and operational challenges as documented within reports and data

  • Influences or provides input to forecasting and planning activities.

  • Tracking and trending data, reporting team key performance metrics, measuring outcomes and implementing process improvement initiatives

  • Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external).

  • Leader in department and team quality projects, accreditation expectations including NCQA, oversight of new services

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Current, unrestricted RN license in the State of Arizona

  • CCM certified or must be willing to obtain the Certified Case Manager (CCM) certification within 2 years of hire

  • 3+ years of experience in healthcare

  • 2+ years of experience as a manager and/or leader of a multi-disciplinary team

  • 2+ years of experience in case management

  • 1+ years of experience with Special Needs Plans (SNP)

  • Experience/exposure with discharge planning, care coordination or transitions of care

  • Background in Medicare products, over 65 populations including elderly, frail co-morbidities

  • Proficient level of experience with Visio, Power Point, Microsoft Word, Excel with the ability to navigate a Windows environment

  • Willing to travel within Maricopa County 25%

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Bachelor’s degree (or higher) in Nursing (BSN) or another health-related field

  • Experience working with Commercial and Medicaid products

  • Experience in Home Health, Hospice and/or Community-Based setting

  • Background in NCQA accreditation process, including setting metrics, report interpretation to meet standards

  • Background in managed care

  • Solid organizational skills and multitasking abilities will be keys to success

  • Solid communications skills including verbal, presentations, and written

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 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

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