Manager of Case Management

UnitedHealth Group•Las Vegas, NV

1d•$91,700 - $163,700•Hybrid

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. We are currently offering a $10,000 sign on bonus for external candidates! This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions. Medical Management includes observation level patients, acute long-term level patients and the development of plans of care to for transitions of care at discharge. This positions is responsible for the daily operations of medical management case managers in the assigned facilities. Collection and oversight of documentation and safety of RN decisions at discharge. Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position. Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members. Ensure members receive quality medical care in the most appropriate setting. Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2) Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

Requirements

High School diploma and/or equivalent
Active unrestricted Nevada RN license
Obtain CCM certification within 2+ years of employment
Valid Nevada driver’s license and maintain personal auto insurance coverage
1+ years of related professional experience in managed care environment
1+ years related supervisory/management experience
Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas
Solid technology skills and excellent interpersonal skills
Proven ability to negotiate and arbitrate without difficulty
Proven ability to supervise multiple levels of people
Critical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

Nice To Haves

Bachelor’s degree
Certification in Case Management (CCM) or equivalent Professional Certification (ACM).

Responsibilities

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requests
Provide support to the team to allow for growth and development and encourage the team to think “out of the box” for solutions
Identify barriers so that staff can maintain high productivity and high levels of morale
Ensure coordination between other internal departments as well as external companies as appropriate
Develop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departments
Independently manage work flows including orientation, standard work and report concerns to the director
Collaborates on decisions to promote teamwork
Collaboration with Sr. Medical Director and V.P.
Promote LEAN work cycles for performance enhancement
Provides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and mission
Other duties as assigned in medical management