The Manager of Care Management position is responsible for leading, directing and overseeing the health plan Care Management Team. The Manager, in close collaboration with the Health Services Director and Medical Director, ensures that the Care Management program results in improved clinical coordination of care and services for all members, thereby achieving established targets and goals. This position serves as a critical member of the Care Management Team, collaborating and communicating with other clnical Care Management staff to enhance the quality and efficiency of health care delivery and promotes health and well being to enrollees. Responsibilities:
Establishes the needed infrastructure and operational processes to support the Care Management program. Maintains staffing ratios within established benchmarks. Identifies, trains and evaluates the Service Coordination staff. Provides coaching and clinical superivsion as needed to improve performance and achieve stated goals. Conducts audits of case documentation to ensure that process standards and inter-rater reliability standards are met and successful outcomes are achieved. Reviews case load data daily and calculates case load every two week and ajusts case loads as needed.
Reviews individual cases with Service Coordinators to help determine if member needs are being properly addresed and to assure that the Seervice Coordinator has awoeking know lege of their members.
Facilitates Medical Director and Service Coordination staff interaction and problem solving. Conducts regular team meetings for communication and feedback, staff training and development, sharing of program results and collaborative problem solving. Is available and accessible to Care Management Team and serves as a clinical resource to support the Care Management Team in conducting clinical review and implementing appropriate follow up interventions.
Assists in managing compliance issues as they relate to the care mangment process and the review process. Ensures training and access to all clinical review tools, case tracking/documentation tools, workflows, discharge planning and risk management referral criteria, and benefit coverage information.
Collaborates with Care Teams and network providers to develop appropriate alternative care and services for members. Educate members, families and providers regarding health care alternatives and applicable benefits. Communicates and collaborates with other members of Care Management Team to improve health care quality and efficiency, develop best practices and identify provider and network issues
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.
Current, unrestricted RN license in the State
Minimum of 3 years experience as a manager
3 years experience in a hospital setting, acute care, direct care experience or experience as a Case Manager for an insurance company, Home Health or Hospice
Intermediate level of experience with Microsoft Word, Microsoft Excel and Outlook with the ability to navigate a Windows environmentDiversity creates a healthier atmosphere: equal opportunity employer M/F/D/V**MEMBERS ONLY**SIGN UP NOW***. 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.