Remote HSS Manager – Fort Worth, TX Market

UnitedHealthcare

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Requisition Number: 2206548
Job Category: Medical & Clinical Operations
Primary Location: Fort Worth, TX
(Remote considered)

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. 

 

In the Health and Social Services Manager role, you will lead a team of Health and Social Services Coordinators, while overseeing day-to-day clinical operations and participating in business development activities. You will manage a program or region, including team and performance management, process improvement, and standardized execution of clinical decision processes, and implementation of new program initiatives. Complying with contractual requirements and ensuring member needs are met.

 

If you reside within a commutable distance of Fort Worth, TX, you will have the flexibility to work remotely* as you take on some tough challenges.

 

Primary Responsibilities: 

  • 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 Medicare requirements and developing care plan around a person’s individuals care needs
  • 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
  • Ability to identify, communicate and apply solutions to remove clinical barriers that may lead to adverse health consequences
  • Solid interpersonal skills that can be applied in developing  collaborative working partnerships with various care teams, multidisciplinary teams and post-hospital partners
  • Cultivate a productive team environment that demonstrates  determination, person centered commitment, focused motivation on quality outcomes  and promoters of quality care plan  management within the department or region
  • Experience developing care plan protocols that are inclusive of caregivers and community resources
  • Define clear team responsibility and accountability in the overall standard of care  of  members
  • Acts as regional interface with other departments to coordinate workflow processes and implementation plans
  •  Support adherence and monitoring of clinical staff performance assessing patient’s clinical needs against established guidelines and/or standards to ensure that the services provided are medically appropriate to a member’s needs
  • Supervise and monitor the necessity, appropriateness and efficiency of services provided
  • Solve problems – This role’s primary responsibility is to be the leadership bridge between where the company is, and where we are going. There are regular changes required to processes and routines that require innovative and flexible execution daily
  • Acts as a conduit for all HealthPlan issues associated with a case to include coordination with all internal departments
  • Understanding Medicaid/LTSS-Medicare differences and effectively and clearly communicating directions to staff, leadership and colleagues

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: 

  • Unrestricted active RN license in TX
  • 3+ years of experience working within the community health setting in a health care role
  • Experience coaching or mentoring staff
  • Experience in developing person centered transition care plans
  • Intermediate level of experience with Microsoft Word, Excel and the ability to navigate a Windows environment

Preferred Qualifications: 

  • Master’s degree
  • Registered Nurse, licensed social worker and/or behavioral health or clinical degree
  • Certified Case Manager (CCM)
  • 3+ year of leadership experience
  • Waiver experience
  • Experience/exposure with discharge planning
  • Experience in utilization review, concurrent review and/or risk management
  • Case Management experience
  • A background in managed care

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

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.