Remote Case and Care Delivery Manager

Optum

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Requisition Number: 2188905
Job Category: Nursing
Primary Location: La Crosse, WI
(Remote considered)

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn’t for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life’s best work.(sm)

The Case Management & Care Coordination Manager will act as a strategic clinical leader across multiple departments, primarily interacting with other clinical leaders, providing oversight to nurse case managers, medical assistants, social workers, and administrative team members, as well as interfacing with the external client. This person will serve as the clinical policy and procedural subject matter expert for World Trade Center (WTC) Health Program unit chiefs on Clinical Center of Excellence (CCE), the primary clinical liaison to teams that review client’s medical records and/or interact with members according to contract requirements, and the medical liaison for internal and external customer needs.

This position will include up to 10% travel.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Residency in the Central Time Zone is preferred.

Primary Responsibilities:

  • Oversee and manage a team of Nurse (RN) Case Management professionals, social workers, medical assistants and administrative staff and is responsible for individual performance and development
  • Leading strategic initiatives associated with the WTC Health Program and the William Street Clinic- Clinical Center of Excellence
  • Forecasting and managing performance in alignment with contractual and business requirements
  • Owns the end-to-end clinical processes for Case Management and William Street Clinic (WSC) including Behavioral Health, Treatment, and Diagnostic Service implementation at the WSC CCE
  • Ensuring medical quality standards for case management and care delivery are met based on contract requirements
  • Provides direct input to clinical training for Optum Serve’s contracted providers and practitioners rendering services for the Survivor cohort with regard to the WTC contract; supports WTC Program Manager, Deputy Program Manager, Medical Director, and Operation Managers in clinical training of internal and external clinical staff, including initial and ongoing education
  • Serves as the primary POC to the Client on case management matters; returns all Program staff inquiries on the same or next business day; attends clinical meetings (Medical Forum, P&T Forum, CM Forum, etc.); clinical and administrative oversight for care coordination
  • Communicates frequently with WTCHP Clinical Team, Unit Chiefs, and Optum Serve Medical Directors and Senior Level Leaders in Optum Serve to establish, improve, and implement contract policies and procedures
  • Provides medical consultation based on review of physical and behavioral health exams, lab results, EKGs, PFTs, other practitioner documentation and specialty exams
  • Reviewing NIOSH clinical policy and working with WTC Program Manager to ensure Optum Serve adherence; will develop and implement internal training to support clinical policy
  • Develop and maintain member Care Plan processes including care audit plan
  • Developing and reviewing utilization management services in accordance with contract standard operating procedure and completes medical certification of contract members
  • Will participate in the strategic evolution of the WSC as a Clinical Center of Excellence, and resolve organizational and operational items within the full WSC CCE supporting operations and shared services organization
  • Participates in internal and external WTC meetings and conference calls, which could entail preparation and presentation of reports
  • Maintains active communication with the CMO and other Optum Serve medical directors with regard to the status of medical issues pertaining to the WTC contract
  • Contributes medical expertise in creation of technical proposals for a variety of business opportunities
  • Implement, improve upon, and uphold the Case Management and Utilization Management Plan including Intensive Case Management (ICM) assignment
  • Receive, review, implement and provide clinical guidance to team to ensure meeting of contractual requirements inclusive of, but not limited to: Performance Objectives, Zadroga Metrics, Technical Guidance Documents & Medical Coverage Determinations
  • Represents Optum Serve during collaboration with entities at UHG and Optum, at the discretion of the CMO

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:

  • Bachelor’s degree in Nursing
  • Active, unrestricted RN licensure in state of residence
  • Active, unrestricted RN licensure in New York and Connecticut _OR_ the ability to obtain New York and Connecticut licensures
  • Active, unrestricted compact RN license _OR_ the ability to obtain a compact RN license
  • 5+ years of demonstrated clinical experience with ability to make independent clinical decisions
  • 3+ years of Case Management experience
  • 2+ years of leadership experience
  • Proven experience with ICD10 and CPT coding including medical terminology
  • Contract management experience
  • Project management experience
  • Knowledge of analyzing and reporting statistical data
  • Demonstrated understanding of regulatory standards and contract requirements
  • Proficient in Microsoft Office Suite, Visio and database experience
  • Demonstrated ability to communicate effectively both verbally and in writing to include technical writing, proofreading, presenting plans, processes, and methodologies to customers
  • Proven ability to manage multiple, complex client relationships with sound judgment
  • Demonstrated ability to research, design, and implement solutions to problems involving analytical and creative elements
  • Proven project and team leadership skills to establish rapport, trust, and confidence with internal departments, staff, and customers

*Equivalent combination of education, experience and/or applicable military experience will be considered.

Preferred Qualifications:

  • Master’s Degree from an accredited university in a relevant clinical program
  • Project management course work or certification
  • National Career Readiness Certificate
  • Unitedhealth Group Culture Ambassador
  • Advanced understanding of workflow processes
  • Solid technical and regulatory knowledge
  • Proven solid organizational, planning, interpersonal and multi-tasking skills
  • Proven self-starter and comfortable with confidential information
  • Proven attention to detail, solid problem-solving and time-management skills
  • Proven ability to work in a fast-paced environment, flexible and adaptable to changing situations, and a solid commitment to teamwork
  • Proven ability to remain calm in stressful situations and to conduct themselves in a professional manner at all times
  • Proven ability to work with a diverse group of people/disciplines to accomplish a client-driven objective
  • Proven exceptional customer-service focus with ability to handle multiple priorities

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy