Director of Social Work

UnitedHealth Group•Rio Grande City, TX

4d•$91,700 - $163,700•Onsite

About The Position

The Director of Social Work is responsible for successfully planning, organizing and directing Enterprise operations for outpatient Social Work and Behavioral Health within Care Management. The Director coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines and NCQA standards; develops and implements policy and procedures; updates and integrates current 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 social worker teams, physicians and staff, market care management teams, corporate departments, vendors, and senior leadership. The position directs long-term planning and regarding Social Work and Behavioral Health and acts as a resource to all internal and external customers. This position is responsible for oversight and evaluation of all Care Management Social Work and Behavioral Health programs. The Director will report to the Vice President of Care Management and 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.

Requirements

Undergraduate degree in behavioral sciences; preferable a Bachelor’s of Science in Social Work
10+ years of experience in social work
minimum of 5 years at a management level
Experience in contract language, claims, Utilization Management guidelines and accreditation guidelines
Ability and willingness to travel both locally and non-locally as determined by business need
Ability to travel up to 30%25 of the time
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Master’s Degree or Higher
Active and unrestricted LCSW license in any US state
Prior multi-site regional operations management responsibilities
Experience with managed care

Responsibilities

Accountable for end-to-end social work/ behavioral health processes
Oversees social work functions and ensures compliance with approved guidelines, government mandated regulations and contractual agreements to include NCQA, URAC and CMS
Manages a team of Licensed Social Work/Behavioral Health Mangers providing direction to ensure effective management and support of SW/BH staff
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
Identifies and resolves technical, operational and organizational problems outside their own team
Responsible for product, service or process decisions likely to impact entire functions and/or customer accounts (internal or external)
Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
Review and Implement Social Work protocols for staff oversight and development
Leverage clinical acumen to provide guidance to staff
Assist staff in navigating the medical management system
Provide oversight and review of coordination of care
Ensure employees are current with clinical licensure and certifications
Develop/oversee/deliver operational or technical training
Fosters leadership skills for supervisor positions to ensure aligned management of staff to include the development of future leadership candidates
Plan, implement, and manage Social Work /Behavioral Health/Community Health worker programs.
Develop policies, procedures, and guidelines for program
Review/approve policy and process changes
Evaluate regulatory changes and determine steps needed to implement in program
Identify and implement business development opportunities to support growth program
Oversee/navigate technology applications utilized in the delivery of program
Intervene in resolution of member or employee complaints or issues as necessary
Create and implement a business continuity plan to minimize interruptions to the business
Promotes communication to members by informing them of updates and revision in policies, using training or orientation opportunities, newsletters, or other available resources such as forum presentations
Cultivates relationships with internal and external groups in support of member education and knowledge sharing
Ensure compliance of Social Work Program and services
Interpret compliance/clinical/medical reports
Evaluate compliance with Federal, State, and Local regulatory and organizational guidelines
Evaluate programs and services against accreditation standards and contractual requirements
Oversee ongoing monitoring and internal auditing against relevant guidelines and standards Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
Measure employee/provider performance against internal procedures and protocols
Ensure team members address gaps in performance against internal procedures and protocols
Monitor and evaluate employee performance and productivity
Develop operations program goals
Develop and communicate performance metrics and expectations
Direct data collection and measurement of outcomes
Apply metrics to evaluate services, employee performance, and program outcomes
Identify causes of performance deficiencies and determine appropriate follow up actions
Drive implementation of best practices and standards
Plan and manage operations to ensure financial viability
Develop operational budgets for medical and clinical operations
Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
Read financial reports, identify reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
Collect and review data to evaluate financial outcomes of programs and services
Conduct cost/benefit analysis on program to drive efficiencies and identify opportunities to enhance financial viability