Remote Manager RN PHM Care Management – Florida

Optum

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Requisition Number: 2197100
Job Category: Nursing
Primary Location: Orlando, FL
(Remote considered)

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.   

The Manager of Case Management is responsible for facilitating communication and directing the operations of all Case Management programs in a defined market.  The Manager leads the market staff on all activities related to medical management initiatives including changes in process, staffing or care delivery model..  Additionally, the manager ensures compliance with all state/federal regulations and NCQA/URAC standards.  The Manager collaborates with the Regional Director of Case Management, medical directors, PCPs, clinic and corporate medical management leadership on care coordination activities.

 

Primary Responsibilities: 

  • Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
  • Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS
  • Engages in Care Team forums/meetings to support care coordination activities between the market providers and the case management team
  • Plans, organizes and oversees staff to ensure timely completion of um determinations, discharge planning and case management assessments
  • Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
  • Adapts departmental plans and priorities to address business and operational challenges
  • Oversees the team’s daily staffing requirements to meet program standards
  • Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
  • Tracks and trends outcomes for potential improvements in the care management process.  Creates monitors, evaluates and disseminates program and productivity reports weekly, monthly, and as needed
  • Interviews, hires, and retains staff to meet the needs of the department
  • Evaluates staff performance and recommend merit increases, promotions, and disciplinary actions
  • Attends, and assists with the facilitation of local market intra-disciplinary care team meetings
  • Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
  • Monitors appropriate utilization of resources, overtime, supplies and mileage
  • Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Performs all other related duties as assigned

 

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 of Science in Nursing (BSN) (4+ additional years of experience beyond the required years of experience may be substituted in lieu of a Bachelor’s degree)
  • Current unrestricted RN license in the applicable state
  • CCM certification or proof that certification has been obtained within one year of hire date
  • 5+ years of healthcare experience to include experience in a managed care setting, hospital setting and/or physician practice setting
  • 3+ years of demonstrated supervisory or management experience with responsibility for team performance management
  • Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
  • Ability to review and interpret data to make recommendations to senior-management
  • Proven data mining, analytical and reporting skills
  • Solid experience with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
  • Ability to travel in and/or out-of-town as deemed necessary by business need
  • This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease

 

Preferred Qualifications: 

  • Master of Science in Nursing
  • Multi-site regional operations management responsibility
  • Solid organizational skills and multitasking abilities

Physical & Mental Requirements:

  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

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.