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 equitable. Ready to make a difference? Join us and start doing your life’s best work.(sm)
The Director of Clinical Programs 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.
If you are located in Hawaii you will have the flexibility to work remotely* as you take on some tough challenges
Primary Responsibilities:
Executes the delivery of all Clinical Programs Case Management/Service Coordination and Population Health/Disease Management within areas of responsibility for the Health Plan
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
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 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
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Current and unrestricted RN or SW licensure active in Hawaii with a degree in Nursing or Social Work
2+ years of experience as a leader with responsibility for leadership development
2+ years of experience with Medicaid/Medicare populations including LTC
2+ years of experience in development and execution of clinical programs in managed care environment
2+ years of experience in telephonic-based and/or field case management including program implementation and monitoring
2+ years of experience in Utilization Management (acute and/or HCBS)
Reside in the State of Hawaii
Proficient in the use of software applications including but not limited to MS Office Suite (Outlook PowerPoint Excel Word Project)
Preferred Qualifications:
Bachelor’s degree
Behavioral Health experience
Reporting Tools (i.e. Tableau Excel Community Care I-CUE etc.)
Demonstrated track record of clinical program compliance functional collaboration and meeting program goals
Careers 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)
At UnitedHealth Group our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race gender sexuality age location and income-deserves the opportunity to live their healthiest life. Today however there are still far too many barriers to good health which are disproportionately experienced by people of color historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.
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.
