Senior Clinical Manager, naviHealth – CST


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Requisition Number: 2233333
Job Category: Medical & Clinical Operations
Primary Location: Eden Prairie, MN
(Remote considered)

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.


As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.


We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.


Why naviHealth? 
At naviHealth, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. naviHealth is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company’s technical vision and strategy.


The Senior Clinical Manager (SCM) is responsible for the management of all clinical functions in the market to ensure consistent, efficient delivery of services throughout the healthcare continuum. The result creates compliance with the clinical model, ensures positive outcomes for patients, and facilitates KPI achievement for the market. The SCM establishes solid relationships with their MA plan or partner hospitals, providers, client peers, and other key market stakeholders.


This position requires input into market-specific strategy and implementation of innovative clinical programs with fidelity to the naviHealth clinical model. This individual assists the Market President in developing strategic direction and creating the annual business plan for the market with consideration to the clinical impact of decisions. The SCM is also responsible for maintaining a positive work environment for our naviHealth colleagues, serving as a communication link to Market Presidents, Corporate Leadership, and Clinical Team Managers and ensuring compliance with all corporate policies and procedures.


Due to business needs, residency in the Central Time Zone is required. The schedule is 8am – 5pm CST Monday – Friday. This position will require up to 20% travel to facilities within a dedicated region which may require overnight travel.


If you are located in the Central Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.


Primary Responsibilities: 

  • Implement and direct naviHealth clinical programs based on the individual needs of clients and propose pilots to Director of Clinical Operations (DCO)
  • Ensure clinically integrated, patient centric care coordination with a focus on appropriate first PAC setting, appropriate PAC LOS, transitions of care, and readmission avoidance
  • Support the concept of being a data driven organization, relying heavily on analytics and outcome reports to drive the business. Includes daily, weekly, and monthly report review and analysis
  • Cultivate a solid internal culture designed around collaboration, feedback, motivation, and accountability. Responsible for clinical operations, quality, and market performance
  • Directly supervise a team of Clinical Team Managers (CTM), including weekly one-on-one meetings and regular colleague performance reviews
  • Work with CTMs to maximize colleague performance using nH based reports, audits, record reviews, and field-based observations
  • Interview, hire, and is ultimately responsible for the competency and compliance of all assigned clinical field staff
  • Participate in MMR, reviews results with CTMs, and create action plans for identified issues.
  • Support the CTM in rounds facilitation, field staff observations, colleague recognition, and coaching when needed
  • Conduct weekly team call with all team members
  • Work with Market Leadership and Human Capital to determine staffing requirements to support work volume
  • May function as a preceptor, mentor, or subject matter expert for new colleagues in the market.
  • Collaborate with Provider Relations Managers to develop business relationships with local providers. Join and contribute to SNF dashboard presentations
  • Work directly with the Market Leadership to review market performance and develop/refine clinical strategy to maximize KPI achievement
  • Evaluate performance to benchmarks, goals and outcomes for all programs as well as high cost, volume and risk conditions
  • May make recommendations on reporting and analytic needs of the market
  • In conjunction with the Market Leadership, attend and participate in the JOC meetings
  • Function as a liaison to the Local Physician Champion (LPC) to manage readmissions and other in market needs
  • Develop relationships with client/partner peers at the hospital and plan level
  • Monitor Compliance to Implementation Protocols and/or Contract SLA
  • Work collaboratively with the Health Services and Utilization Management departments and programs to ensure positive outcomes
  • Monitor feedback from member satisfaction surveys and provider feedback and identifies process improvement opportunities
  • Ensure compliance with all federal and state regulations, accreditation organizations, and client requests
  • Perform other duties and responsibilities as required, assigned, or requested


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:    

  • Active, unrestricted registered clinical license required in state of residence – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist
  • 5+ years of advanced clinical experience
  • 5+ years of leadership experience in an inpatient and/or outpatient health care environment
  • Experience managing multi-disciplinary care teams including nurses, therapists, social workers, case managers
  • Demonstrated familiarity with care management, utilization/resource management processes, and disease management programs
  • Proficient with Microsoft Office applications including Outlook, Excel, and PowerPoint
  • Access to secure high-speed internet at home via cable broadband, DSL, or fiber
  • Dedicated, distraction-free workspace at home
  • Ability to travel up to 20% of the time to facilities within a dedicated region including potential overnight travel
  • Reside in the Central Time Zone


Preferred Qualifications: 

  • Experience in project management and program development/implementation
  • Proven understanding of the evolving health care market and ability to work collaboratively with physicians
  • Proven knowledge of NCQA and URAC standards
  • Proven ability to interact with other clinicians, senior management, patients and their families, and all levels of medical and non-medical professionals
  • Proven ability to establish realistic and achievable priorities, goals, and objectives
  • Proven solid presentation/public speaking skills
  • Demonstrated clear, concise, and persuasive verbal and written communication
  • Proven excellent analytic skills

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.