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Director, Complex Care Management - Sugar Land, TX

Company: UnitedHealth Group
Location: Sugar Land
Posted on: January 14, 2020

Job Description:

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) This is an office position in Sugarland, Texas . The leadership of the health plan also has a strong culture of regular in-person meetings among its leadership and frequent in-person contact with direct reports. It’s important for this candidate to be located near Houston, Sugarland area. Primary Responsibilities: Responsible for executing disease management, complex care management, and designated required state assessments for the STAR+PLUS, STAR Kids, STAR, CHIP, MMP and Dual Special Needs Plan products Navigates a challenging matrix environment, leads multi-faceted and multi-functional teams with a strong ability to problem solve and leads and motivates others in problem resolution.  The Director coordinates, leads, and completes innovative projects across various functional areas Reports to the Chief Medical Officer, and also collaborates closely with the Senior Director of Quality Management, the Director of Alternative Payment Models, the Director of Project Management and Analytics, the Accountable Care Transformation Consultant, and the health plan Executive Directors of the individual Texas Medicaid products (noted above).  The Director leads a team of five to eight managers, and collaborates closely with a second Director of Complex Care Management, who has similar responsibilities Participates in all meetings related to state Pay for Quality program, workgroups on quality improvement and specific clinical care management initiatives and practice transformation initiatives Participates in clinical team huddles, operations reviews with the Accountable Care Transformation Consultant, case conferencing with patient care team, and periodic JOC meetings with community based organizations, physician practices and hospitals to report progress on high risk patients and overall progress against goals Responsible for key internal stakeholder liaison relationships with UCS Inpatient Care Management team (especially to support discharge planning and transitional care management activities), Optum Behavioral Health (especially to support medical behavioral integrated case conferencing series, telemedicine initiatives and other special projects), Optum RX (for integration of pharmacy clinical initiatives into DM/CCM activities), and others Provides oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company Maintains organizational structure and oversight of procedures, employment, training, and supervision of all Disease Management and Complex Care Management staff Coordinates duties with appropriate personnel in the health plan’s Health Services department, Quality, Provider Relations, Compliance, other internal stakeholders described above, and others, to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicaid and Medicare guidelines, and accrediting body 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: Texas licensed RN, active and unrestricted license Clinical experience caring for patients with chronic medical conditions (and chronic psychiatric conditions) 5+ years of utilization management and/or disease management experience in managed care with health plans 3+ years of management-level experience (at manager level or above) in health care  (at payer and/or provider) Experience in contract language, claims, utilization management guidelines, and disease management pathways Knowledge of federal and state laws and accrediting body regulations relating to managed care, disease management, utilization management, discharge planning and complex care case management Knowledge of fiscal management and human resource management techniques Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities Intermediate to advanced level of proficiency with MS Word, Excel, and PowerPoint Candidate must be able to work in Sugarland, Texas office Candidate must live in or near Houston, Texas area Preferred Qualifications: Bachelors of Science Project management experience (tracking, planning projects, working with healthcare data sets and making data-driven analytical decisions 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 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. Job Keywords: federal and state laws and accrediting body regulations relating to managed care, disease management, utilization management, discharge planning and complex care case management, Director, Manager, fiscal management, human resource, contract language, claims, utilization management guidelines, disease management, federal, state laws, accrediting body regulations, Project management experience, RN, Nurse, Registered Nurse, state assessments ,STAR+PLUS, STAR Kids, STAR, CHIP, MMP, Dual Special Needs Plan products, Sugar Land, Texas, TX

Keywords: UnitedHealth Group, Sugar Land , Director, Complex Care Management - Sugar Land, TX, Other , Sugar Land, Texas

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