Case Manager - Manager- Remote in MA

apartment UnitedHealthcare location_onWorcester, MA, US

$89,900 - $160,600 / YEAR

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 to start Caring. Connecting. Growing together.

UnitedHealthcare Community & State Senior Care Options plan is a Fully Integrated Dual-Special Needs Plan (FIDE-SNP) serving dually eligible individuals in the Commonwealth of Massachusetts aged 65 or greater. This position reports to the Health Services Director in the Health Services Department within the Senior Care Options Plan. This position sets team direction, resolves problems and provides direction to nurse case managers. This position adapts departmental plans and priorities to address business and operational challenges such as staffing, the clinical model and inter-departmental actions and goals. 10% of expected travel within Massachusetts.

If you reside near Worcester, MA, you will enjoy the flexibility to telecommute* as you take on some tough challenges."

Leadership

Primary Responsibilities:

Supervises a team that varies in size based upon Capacity Plans and staffing models. Direct reports are located at same site, at home or at a remote UHC site
Hires, manages and develops new employees and proactively monitors individual and team performance by providing frequent, ongoing feedback and coaching
Implement strategies to improve operational performance, quality and delivery service to constituents
Leads regular team meetings to communicate changes, relevant operational performance information and/or to build employee engagement
Utilizes Our United Culture concepts and tools and delivers on the commitments
Demonstrates a positive leadership shadow by shaping positive behaviors in areas of influence, building integrity, influencing our values and creating a healthy, high-performance environment

Drive Effective Clinical Decisions within a Business Environment: Operational Performance:

Develops and/or implements bottoms-up strategies to improve operational performance
Continually stays abreast of operational performance, identifies degradation in service levels and leads to remediation of issues
Responsible for the interview and selection decisions on new hire staffing within their own hierarchy
Accountable for a successful new hire onboarding experience
Responsible for creating a positive and meaningful onboarding experience for all employees
Delivers and documents one-on-one coaching to improve all aspects of performance and effectiveness
Completes "side-by-side" monitoring/coaching with direct reports on a regular basis
As needed, prepares, delivers and manages remediation plans
Participate in job fairs, open houses and other recruitment events as needed
Ensure compliance with Model of Care and State contractual requirements (Chart audits)
Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results
Use appropriate business metrics (e.g. member/FTE, length of stay, readmission rates, STAR ratings, member engagement rates) and applicable processes/tools (e.g. cost benefit analysis, return on investment, performance, staffing calculator) to optimize decisions and clinical outcomes
Prioritize work based on business algorithms and established work processes, or in their absence, identify business priorities and build consensus to triage and deliver work (e.g. assessments, case/claim loads, previous hospitalizations, acuity, morbidity rates, quality of care follow up)
Understand and operate effectively/efficiently within legal/regulatory requirements (e.g., HIPAA, CMS, State)

Coaching & Performance Management

Communicate with direct reports on a regular basis through coaching sessions and by providing timely, actionable feedback
Ensures performance metrics and goals are reviewed on a regular and frequent basis, with time set aside for incidental issues
Provides purposeful and actionable development feedback to direct reports and monitors to support their performance improvement
If, after the action items of the development plan do not yield the desired positive results in the agreed upon timeframe, CAP is initiated in accordance with UHG policies and practices
Works with HRdirect on disciplinary actions or terminations and seeks manager approval on all terminations
Tracks and manages attendance and punctuality in a timely and accurate manner

Development & Employee Engagement

Prepares and delivers thorough and meaningful performance discussions and documents with data and fact-based examples to reduce ambiguity of ongoing expectations
Creates purposeful and actionable development plans, reviews with employees and monitors to support their performance improvement expectations and development
Engages in regular, meaningful and candid development and career discussions with direct reports
Guides employees to leverage available training and development resources
Analyzes and understands Employee experience survey results and communicates results to team members
Works to establish an action plan to address opportunity areas and improve results
Supports overall organization in employee engagement programs and communications

Communication

Holds consistent 1:1meetings with direct reports
Regularly leverages various communication channels, including one-on-ones and new hire class leadership interactions to foster two-way communication. Inspires employees to see the link between their position and personal performance to organizational strategy, company performance and the UHC brand

Demonstrate Business And Industry Knowledge

Demonstrate knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
Demonstrate knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid,) or regulatory bodies (e.g., EOHHS, HIPAA, Milliman)
Demonstrate understanding of relevant health care benefit plans
Demonstrate knowledge of applicable area of clinical specialization
Utilize resources to enhance professional practice and development based on learning gaps or new information

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

Unrestricted Nursing license in the state of MA
5+ years of care management experience and/or 5+ years of equivalent clinical knowledge and experience such as social care, healthcare coordination, quality improvement
1+ years of experience with SharePoint and shared network drives
Intermediate level of proficiency with Microsoft Office applications, including Word, Excel and PowerPoint
Access to reliable transportation and valid US driver's license

Preferred Qualifications

BS / BA Degree
3+ years of leadership experience
Proven ability to focus activities on a strategic direction and achieve targets
Time management and prioritization skills
Strong written and verbal professional communication skills
Excellent team development skills
Strong interpersonal skills
Ability to work in a self-directed manner in a fast-paced, rapidly changing environment
Demonstrated leadership abilities
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN

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Assures accurate inventory of supplies based on approved levels. Rotates stock as required. Initiates requisitions for re-supply or special items. Issues and verifies patients managed care referral. Collects copays from patients for visits, maintains records and reconciles daily deposits. Completes tasks associated with clinical inbox/ practice buckets (personal, practice referral, medical record and others assigned) proficiently and in a timely manner. Instruments and equipment are prepared and sterilized according to procedure to support infection control. Attends variety of meetings, conferences, and seminars as required or directed. Complies with established departmental policies, procedures, and objectives. Demonstrates use of quality improvement in daily operations. Complies with all health and safety regulations and requirements. Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. Provide coverage when needed at other locations within Heywood Medical Group. All other duties and locations as assigned. Statement of Other Duties This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described. Qualifications JOB REQUIREMENTS Minimum Education High School diploma or equivalent required or must obtain within six months of employment Completion of accredited program in Medical Office Assisting (MOA) at an accredited school, or relevant job experience preferred. Required Certifications CMA/RMA or equivalent required. (Candidates with appropriate training or experience can obtain certification within six months of employment). BLS through American Heart Association required or must obtain within six months of employment Minimum Work Experience Experience in a medical office preferred. Required Skills Excellent written and verbal communications skills preferred. Proficiency with computers and electronic medical records is required. Ability to work flexible shifts, evening, and weekends required. Reliable transportation for travel between locations required. FUNCTIONAL DEMANDS Physical RequirementsExerts up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), and handles (seizing, holding, grasping, turning, or working with hands).