Medical Director careers at UnitedHealth Group are anything but ordinary. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. of seeing a handful of patients each day, your work may affect millions for years to come. Join us. And start doing your life's best work.(sm) The Health Services Director is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). Function provides leadership to and is accountable for the performance of managers and / or senior level professional staff. Primary Responsibilities:Executes the delivery of all Clinical Programs Case Management / Service Coordination and Disease Management within areas of responsibility for the Health Plans Develops and implements clinical program structure and resource plans that are consistent with National Clinical Model based on populations serviced by Plan and revenue models Ensures local service coordination processes, policies and procedures meet regulatory / NCQA / CMS standards and are consistent with the national clinical model Leads, coaches, develops, clinical leadership staff, fosters innovation to improve member outcomes Ensures monitoring and oversight of clinical programs / staff to meet defined goals / targets, contract requirements Acts as administrative liaison between the health plan and the various State entities for the MLTSS Care Management requirements Works collaboratively with providers, sister-segments, 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, SSI / ABD, long term care, and dually eligible categories, improving cost efficiencies and developing an environment of operational excellence Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations Develops, translates and executes strategies or functional / operational objectives for Health Plan including medical management, financial accountability, customer and Provider satisfaction, quality improvements Develops and implements staff retention and engagement program Ensures clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and clinical model standards
Required Qualifications:Current and unrestricted New Jersey licensure with a degree in Nursing Four years experience with Medicaid / Medicare populations, including LTC and TANF / CHIP Experience in development and execution of clinical programs in managed care environment Experience in field-based case management, including program implementation and monitoring Experience in Utilization Management (acute and / or HCBS) Demonstrated track record of clinical program compliance, functional collaboration and meeting program goals Experience as a leader with responsibility for leadership development Proficient in the use of software applications including, but not limited to MS Office Suite (Outlook, PowerPoint, Excel, Word, Project)Preferred Qualifications:Master's degree in health related fieldCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Associate Health Services Director, LTSS, Edison, NJ, New Jersey
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.