UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
UnitedHealthcare Community & State provides high-quality, personalized, public sector health care programs that are more affordable and sustainable and improve the health of approximately 2.4 million recipients of Medicaid, State Children's Health Insurance Programs, Special Needs Plans, and related government sponsored health care programs.
One Care is a fully integrated Medicare and Medicaid product that serves individuals between the ages of 21 and 64 who have physical and intellectual disabilities.
We are currently looking for an Associate Director of Medical and Clinical Operations to join our team in Waltham, MA.
Reporting to the Senior Director of Health Services, the Associate Director of Medical and Clinical Operations is responsible for the oversight, development, implementation and maintenance of clinical and medical operations that meets the needs and challenges of the geriatric Enrollees of the Senior Care Options (SCO) program. They also oversee daily team operations and provide strong leadership through training, coaching, teaching, and managing assigned teams.
If you are located in Boston, MA, you will have the flexibility to telecommute* as you take on some tough challenges.
Manages a staff of telephonic care coordinators, registered nurses and clinical administrative support staff and monitors department activities to evaluate the productivity and quality of programs and processes in order to identify potential improvements and to ensure alignment with corporate goals
Oversees all aspects of the assessment submission process to EOHHS to ensure that members are correctly risk stratified
Recommends and participates in departmental policy and procedure development and ensures that policies and procedures are enforced and in alignment with the care management model to ensure compliance with all contractual and regulatory requirements
Acts as the primary health plan clinical liaison to with United Clinical Services to coordinate utilization management activities
Participates as an active member of the health plan's Utilization Management and Quality Management committees to ensure the authorization processes and quality initiatives support a system in which Enrollees have input, choice, control, and access to a comprehensive range of services that allows for independence, health and quality of life
Attends activities including social and other professional organizations
Keeps current with all clinical affairs trends, policies, practices, and workflows
Maintains professional growth and development through self- directed learning activities and involvement in professional, civic, and community organizations
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.
Bachelor's degree or Higher
3+ years of managerial experience
Experience in Medicaid, Medicare Advantage, and home and community-based service delivery
Experience in health care utilization data analysis for the identification of cost savings and quality improvement opportunities
Bilingual in Spanish
Solid oral and written communication skills; ability to interact with all levels of internal and external contacts
Ability to prioritize, plan and handle multiple task/ demands simultaneously
Ability to analyze and integrate information and make sound decisions based on established guidelines
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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)
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 Director Medical and Clinical Operations, Medicaid, Medicare, Healthcare, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, oston, Waltham, MA, Massachusetts
Unitedhealth Group Inc.