Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions (administrative support and UM Nurse Team oversight), or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.
â€¢ Manage and is accountable for Administrative and Clinical Supervisors and indirectly UM Nurses
â€¢ Provide oversight and review of coordination of care
â€¢ Develop/oversee/deliver operational or technical training
â€¢ Develop policies, procedures, and guidelines for clinical operations
â€¢ Review/approve policy and process changes
â€¢ Evaluate regulatory changes and determine steps needed to implement in programs
â€¢ Identify and implement business development opportunities to support growth of medical and clinical operations programs
â€¢ Oversee/navigate technology and software applications utilized in the delivery of clinical operations
â€¢ Oversee management/service delivery systems utilized in member care
â€¢ Intervene in resolution of member or employee complaints or issues as necessary
â€¢ Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
â€¢ Measure employee/provider performance against internal procedures and protocols
â€¢ Ensure team members address gaps in performance against internal procedures and protocols
â€¢ Develop and communicate performance metrics and expectations
â€¢ Direct data collection and measurement of outcomes (e.g., customer surveys)
â€¢ Apply metrics to evaluate services, employee performance, and program outcomes
â€¢ Read and interpret reports (e.g., performance, service)
â€¢ Identify causes of performance deficiencies and determine appropriate follow up actions
â€¢ Drive implementation of best practices and standards
â€¢ Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
â€¢ Read financial reports, Identify reasons for financial performance gaps, and Identify opportunities for improved financial performance and enhanced return on investment
â€¢ Collect and review data to evaluate financial outcomes of programs and services
â€¢ Conduct cost/benefit analysis on programs to drive efficiencies
â€¢ Conduct competitive analysis and identify opportunities to enhance financial viability
â€¢ Propose and obtain approval for capital expenditures for medical and clinical operations
â€¢ Bachelorâ€™s degree or equivalent experience
â€¢ A minimum of 2 years of experience with Medicaid/Medicare populations, including LTC and TANF/CHIP
â€¢ A history of progressive responsibility in clinical operations environment demonstrating familiarity with a comprehensive range of administrative service assignments
â€¢ At least 1 year of experience in Utilization Management (acute and/or HCBS)
â€¢ A minimum of 2 years of experience in a leadership role
â€¢ Proficient in the use of software applications including, but not limited to MS Office Suite (Outlook, PowerPoint, Excel, Word, Project)
â€¢ Demonstrated ability to successfully deliver outcomes in a timely and effective manner
â€¢ Experience leading or participating in performance improvement teams
â€¢ Demonstrated ability to work collaboratively and effectively at all levels, across the organization and within own work group
â€¢ Healthcare Administration or Project Management degree
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
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.
When you work to better people’s lives, one of those lives will always be yours.
We have modest goals: Improve the lives of...