Health Services Director - Remote in Nebraska

UnitedHealth Group•Omaha, NE

3d•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Health Services Director (HSD) is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care and medical management consulting. The HSD may also be responsible for directing health education, coaching and treatment decision support for members. This Director will provide oversight and leadership to nurse clinicians responsible for the care management activities. The HSD must live in Nebraska. If you reside in Nebraska, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

RN or LIMHP with current, unrestricted licensure in Nebraska
8+ years of clinical practice experience
4+ years of demonstrated management, leadership and team development experience
3+ years of experience in managed care Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements
Experience working with government contracts and/or State agencies required
Demonstrated ability to assist with focusing activities toward a strategic direction as well as developing tactical plans, drive performance and achieve targets
Proven solid problem solving and analytic skills, with ability to draw relevant conclusions and devise appropriate courses of action
Proven clear, concise presentation level communication skills and ability to convey complex or technical information in easily understandable terms; ability to interpret complex info from various sources
Demonstrated track record of clinical program compliance
Demonstrated ability to lead, influence and develop/mentor staff
Proven adept in cross functional interactions, collaboration and meeting program goals
Proven ability to influence in a matrix environment
Proven excellent proficiency with MS PowerPoint, Excel, Word
Resident of Nebraska
Driver’s License and access to a reliable transportation

Nice To Haves

Certified Case Manager
Medicaid Managed Care Long Term Care Programs experience
Field based case management program implementation and monitoring

Responsibilities

Executes the delivery and governance of all Clinical Programs (Utilization Management, Care Management/Service Coordination and Disease Management) for the Health Plan
Oversees the MCO’s case management functions and ensures member’s needs are met and policies/protocols comply with all state and federal requirement.
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
Identifies and resolves technical, operational and organizational problems outside own team
Product, service or process decisions with likely impact entire function and/or customer accounts (internal or external)
Develops, translates and executes strategies or functional/operational objectives for a Health Plan clinical team including medical management, financial accountability, customer and Provider satisfaction, and quality assurance
Work autonomously to identify issues, develop action plans and implement changes to positively impact business function
Develops and implements the clinical program structure and resource plans that are consistent with National Clinical Model based on populations serviced by Health Plan
Ensures local clinical processes, policies and procedures meet regulatory/NCQA/CMS/State of NE DHHS standards and are consistent with the national clinical model
Leads, coaches, develops the clinical leadership staff and fosters innovation to improve member outcomes
Identifies and drives local Healthcare Affordability Initiatives along with Medical Director and clinical team
Ensures monitoring and oversight of clinical programs/staff to meet the defined goals/targets and contract requirements and to promote data driven development
Uses data effectively to monitor and develop programs and processes to address areas of priority or opportunity
Works collaboratively with providers, internal and external business partners, state departments, community based organizations, service contractors, and health plan management to oversee the management of a health services department with the objectives of improving the quality of care delivered to members in a range of products, i.e., Medicaid, CHIP, ABD and dual eligible categories, improving cost efficiencies and developing an environment of operational excellence
Serves as the primary clinical contact for the State for inquires, State Fair Hearings, clinical state meetings, implementation of clinical programs and interfaces with other MCO’s in market to collaborate on health services initiatives.
Assists with development and support of medical home processes
Identifies operational efficiencies to enhance operations, reduce operating costs, and standardize best practices across the organization
Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations
Collaborates with internal and external entities to improve accessibility standards and quality practice standards to reduce medical costs across the service delivery systems (inpatient, emergency departments, urgent care services and practitioner office settings)
Utilizes timely, meaningful financial and utilization reports to assist providers in efforts to alter their care delivery patterns and improve member outcomes
Develops and implements staff retention and engagement program and serves as the Health Plan Health Services SME and liaison with the state
Ensures clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and clinical model standards