UnitedHealth Group Associate Dir.Health Services-Complex Care - UHC Comm. Plan of Texas in Houston, Texas
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) The Associate Health Services Director (AHSD) provides strategic leadership and is accountable for community dwelling nursing facility level of care membership, oversight of MMP and Dual Special Needs members also serviced by the health plan. This individual is responsible to ensure contractual compliance and achievement of clinical, quality / affordability, and utilization management goals for all products. The AHSD serves as the primary point of contact and is accountable for all aspects of health plan clinical and utilization management performance for the designated lines of business. Because of the unique structure and alignment of clinical programs within United Healthcare, this role requires a high degree of coordination with external and internal business partners, and other clinical specialty, external vendors and / or national programs. The AHSD will work collaboratively with the Health Plan Director of Quality and Plan Medical Director to support achievement of state and federal quality and STAR initiatives. Additionally, this individual will work collaboratively with the Plan Medical Director, business partners and Finance to develop, implement / execute the Healthcare Affordability Plan, monitor outcomes of the planned initiatives and adjust the Plan as needed to meet targets.
This individual will support the Compliance Program in promoting awareness of applicable program regulations that define the standard of organizational values regarding regulatory compliance. The Associate Health Services Director must possess a solid knowledge of all applicable lines of business, product and cohorts within the health plan operations from a clinical standpoint. Primary Responsibilities: Responsible for operational development and implementation for Nursing Facility clinical care coordination model inclusive of SOP and workflow development Will work in conjunction with other teams for MMP and DSNP SOP and workflow development Responsible for providing direct oversight of the Nursing Facility services Clinical Service Coordination team Downward reporting structure consists of RN Management team, RN clinical case managers, and non-clinical administrative support Responsible for collaborating with State partners and providers to support appropriate execution on Managed Medicaid program benefit goals and initiatives Responsible for relationship and rapport building with HHSC, Nursing Facilities, and DSNP and MMP constituents Required Qualifications: Active RN licensure in State of Texas Bachelor's Degree in business, nursing, or related field Master's Degree Preferred 3+ years progressively responsible healthcare leadership experience Significant experience in development and execution of clinical programs in public sector integrated model managed care environment (5+ years) Computer / typing proficiency including use of Microsoft Office Suite applications Problem solving proficiency; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action 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 Preferred Qualifications: Medicaid managed care experience in facility-based long term services and support Masters in Nursing or related area 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.
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. b0269d7f-6385-4ff1-b705-7c5ae5fd5f77
Associate Dir.Health Services-Complex Care - UHC Comm. Plan of Texas TX-Houston 684918