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　　Responsible for overseeing case management processes to ensure patients benefit from teammates clinical expertise. The case management team of nurses and social workers work with patients to ensure cost-effective, positive outcomes while helping educate and navigate patients and their families through the complex healthcare system. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. This is performed under the general supervision of the Director of Care Management. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other required training is a condition of employment.

　　Primary Responsibilities:

　　Manages an integrated team responsible for complex case management, disease management, care coordination, and population health management

　　Responsible for care management functions, coordinating and monitoring clinical and non-clinical team activities to facilitate integrated, proactive case management (CM), ensuring compliance with regulatory and accrediting standards

　　Manages and evaluates teammates including remote-based teammates in the performance of various CM activities; provides coaching, counseling, employee development, and recognition; and assists with selection, orientation and mentoring of new team members

　　Ensures that teammates complete quality audit reviews

　　Performs and promotes interdepartmental integration and collaboration to facilitate the continuity of care including transitions of care

　　Maintains adequate staffing, service levels and customer satisfaction by implementing and monitoring teammate productivity and other performance indicators

　　Reports on CM statistics including teammate productivity, cost effective utilization of services, management of targeted member population, referrals to case management and triage activities

　　Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and team development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines including HIPAA

　　Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement

　　Communicates with management regarding development within areas of assigned responsibilities and works on special projects as required

　　Identifies and addresses opportunities for quality improvement in all aspects of serving our customers

　　Assists in planning and implementation of systems changes and procedures to achieve overall organizational objectives

　　Other duties as assigned

　　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

　　3+ years of experience as a manager

　　3+ years of experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company

　　Demonstrated basic level of experience with Microsoft Word, with the ability to navigate a Windows environment

　　Ability to travel between offices and facilities for training and meetings (25%)

　　Preferred Qualifications:

　　BSN

　　Certified Case Manager (CCM)

　　Experience in managed care

　　Case management experience

　　Experience/exposure with discharge planning

　　Experience in utilization review, concurrent review and/or risk management

　　Solid organizational skills and multitasking abilities will be keys to success

　　At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

　　Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

　　OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.