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Director of Clinical Programs - Remote in Hawaii

Company: UnitedHealth Group
Location: San Diego
Posted on: November 26, 2022

Job Description:

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 and start doing your life's best work.(sm)

If you are located within the state of Hawaii, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

  • Executes the delivery of all Clinical Programs Case Management/Service Coordination and Population Health/Disease Management within areas of responsibility for the Health Plan
  • Develops and implements clinical program structure and resource plans that are consistent with National Clinical Model based on populations serviced by Plan and revenue models
  • Ensures local service coordination processes, policies and procedures meet regulatory/NCQA/CMS standards and are consistent with the national clinical model
  • Leads, Coaches, develops, clinical leadership staff, fosters innovation to improve member outcomes
  • Ensures monitoring and oversight of clinical programs/staff to meet defined goals/targets, contract requirements
  • Works collaboratively with providers, sister-segments, service contractors and health plan management to oversee the management of a health services department with the objectives of improving the quality of care delivered to members in a range of products, i.e., Medicaid, SSI/ABD, long term care, and dually eligible categories, improving cost efficiencies, and developing an environment of operational excellence
  • Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations
  • Develops, translates and executes strategies or functional/operational objectives for Health Plan including medical management, financial accountability, customer and Provider satisfaction, quality improvements
  • Develops and implements staff retention and engagement program
  • Ensures clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and clinical model standards

    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:

    • Current and unrestricted RN Hawaii licensure with a degree in Nursing
    • 2+ years of experience as a leader with responsibility for leadership development
    • 2+ years of experience with Medicaid/Medicare populations, including LTC
    • 2+ years of experience in development and execution of clinical programs in managed care environment
    • 2+ years of experience in telephonic-based and/or field case management, including program implementation and monitoring
    • 2+ years of experience in Utilization Management (acute and/or HCBS)
    • Demonstrated track record of clinical program compliance, functional collaboration, and meeting program goals
    • Proficient in the use of software applications including, but not limited to MS Office Suite (Outlook, PowerPoint, Excel, Word, Project)
    • Reside in state of Hawaii

      Preferred Qualifications:

      • Bachelor's degree
      • Behavioral Health experience
      • Reporting Tools (i.e., Tableau, Excel, Community Care, I-CUE, etc.)

        To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

        Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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

        Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

        UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, San Diego , Director of Clinical Programs - Remote in Hawaii, Healthcare , San Diego, California

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