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Care Management Manager - The Contractor must employ a full-time Care Management Manager dedicated to the Hoosier Care Connect program. This Manager must oversee the disease management, care management, complex case management and Right Choices Program (RCP) functions as outlined in Section 5.0. The Care Management Manager must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to a variety of populations. This individual will work directly under the Contractor's Medical Director to develop, expand and maintain the care management program. The individual will be responsible for overseeing care management teams, care plan development and care plan implementation. The Care Management Manager will be responsible for directing the activities of the care managers. These responsibilities extend to physical and behavioral health care services. This individual will work with the Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Management Manager will provide input, as requested by the State, at State-level meetings.
If you are located in Indianapolis, IN, you will have the flexibility to telecommute* as you take on some tough challenges.
Selects, manages, develops, mentors and supports staff in designated department or region
Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
Acts as regional interface with other departments to coordinate workflow processes and implementation plans
Resolves inpatient and outpatient provider authorizations and collaborate with Provider relations to assist in Provider resolutions
Participates in training and coaching of direct reports as needed
Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Review and disseminate report inpatient census report for NF case
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.
BSN or equivalent experience
Registered Nurse with an unrestricted License in Indiana
Experience working within the community health setting in a health care role
Experience in an Indiana Managed Care Organization
Experience coaching or mentoring staff
Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
3 year of case management leadership experience within a healthcare industry
Background in managed care
Case Management experience
Certified Case Manager (CCM)
Experience / exposure with discharge planning
Experience in utilization review, concurrent review and/or risk management
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Manager, Care Management, Care Management Manager, Hoosier, Care Connect, Registered Nurse, RN, Indiana Managed Care Organization, Case Management, Certified Case Manager, C&S, Community & State, UHC, UnitedHealth Care, UHG, UnitedHealth Group, Telecommute, Telecommuting, Telecommuter, Remote, Work From Home, Indianapolis, IN, Indiana
Unitedhealth Group Inc.