Remote Senior Clinical Program Manager RN


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Requisition Number: 2184548
Job Category: Medical & Clinical Operations
Primary Location: Omaha, NE
(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. 

The Senior Clinical Program Manager develops and implements (with support from National Resources) appropriate clinical models for Special Populations served based on state contract deliverables, national established clinical models and within financial reimbursement model / contract funding.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: 

  • Ensures business processes are in place to monitor and manage Special Populations, operational processes as defined by the state contract and / or national standardized model components
  • Develops, implements and monitors Special Program clinical processes metrics and monthly report cards for the various programs
  • Assists with development of policy, procedure, standard operating procedure, workflow, job aides, training materials for Special Programs or other health plan initiatives
  • Under the direction of the Health Services Director, acts as a contact to the State Program Managers, attend state meetings when needed, work with the State on policy decisions if needed, support implementation of the new policies at the health plan, create policies, SOP’s and JA’s, auditing of clinical programs
  • Develops and manages Special Program OR other clinical project / program work plans to achieve objectives
  • Facilitates cross-functional and / or cross-segment teams
  • Predicts emerging customer needs and develops innovative solutions to meet them
  • Solves unique and complex problems with broad impact on the business
  • Participates in the development of business strategy
  • Translates highly complex concepts in ways that can be understood by a variety of audiences
  • Influences senior leadership to adopt new ideas, programs, and / or approaches

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:

  • Registered Nurse, Social Worker or related Health Care or Clinical Operations and Program Management experience
  • 5+ years of clinical programs / professional experience (Preferably in Managed Care, Medicaid/Medicare Programs, Home Health, Hospice or Long-Term Care)
  • 5+ years of Project / Program management experience
  • 3+ years Leadership experience
  • Demonstrated ability to assist with focusing activities on a strategic direction as well as develop tactical plans, drive performance and achieve targets.
  • Proficiency in software applications that include, but are not limited to, Microsoft Word, Excel and PowerPoint
  • Knowledge of platforms including Community Care, ICUE, RX Claims
  • Proficiency in writing Policies, Procedures and Program Descriptions

Preferred Qualifications:

  • Bachelors or master’s level Degree in Science or Business
  • Experience in Medicare or Medicaid Managed Long Term Care clinical programs
  • Experience in health care and insurance industry, including regulatory and compliance requirements
  • Analytics/database experience
  • Experience training clinical staff
  • Experience presenting in a group setting
  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • Demonstrates excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Demonstrated ability to assist with focusing activities on a strategic direction as well as develop tactical plans, drive performance and achieve targets

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 $67,800 to $133,100 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