Associate Vice President, Care Management Operations - 933080 - Lubbock - 79416

Company: unitedhealthgroup
Location: Lubbock
Posted on: June 12, 2021

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your lifes best work.(sm)

The Vice President of Medical Management Operations is responsible for successfully executing all Medical Management activities for their region. The Vice President is responsible for planning, organizing, and directing the administration of all Medical Management Programs such as Care Management (Utilization Management, Case Management, Disease Management), Advance Care Management (Palliative Care), and Quality programs. The VP provides oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.

The VP maintains organizational structure and oversight of procedures, employment, training, and supervision of all Medical Management staff. The VP directs long-term planning and communication regarding Medical Management issues with network physicians; and acts as a resource to all internal and external customers. The Vice President coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines, NCQA and URAC standards. The Vice President implements policy and procedures to maintain corporate and service initiatives. The Vice President integrates current clinical practice guidelines for care management services. The Vice President is also responsible for cultivating new leadership for the department.

Primary Responsibilities: Leadership. Directs the overall activities of staff in the department. Serves as source of expert knowledge for all activities undertaken in the department. Establishes priorities for staff, and facilitates bilateral communication between line staff and department management. Serves as contact for communication and problem resolution for issues raised by managers from other departments. Presents professional appearance and demeanor at all times Committee Support. Actively participates in Medical Management and Quality Committee. Accountable for disseminating information to the Committee regarding market activities. This involves annual evaluation of the program with recommendations for revision as indicated. Actively participates in committees such as Medical Finance, market monthly strategic meetings, and other care management related committees Compliance. Oversees and ensures that Care Management and Quality staff adhere to all regulations, contractual agreements, and applicable NCQA/URAC and other applicable accreditation standards. In addition, ensures adherence to other UM/CM/DM delegated agreement standards and expectations for all contracted health plans. Ensures internal audits are conducted, reviews results, formulates and implements appropriate action plans to correct any areas on noncompliance. Collaborates with Training to provide in-services on compliance to better prepare the department for audits. Makes recommendations for revisions and updates in structure and procedure to the enterprise VP and MM/Quality Committee for improvements to Medical Management functions and implements any new procedures Customer Service. Implements Medical Management programs in a manner that provides a high level of service to patients and providers, and is no more burdensome than necessary to manage the care effectively and efficiently Staff. Manages staffing ratios of all personnel, the assignment of duties, the supervision of the effectiveness of the Medical Management programs related to staff, within the structure of the budget for the department. Ensures staff have access to necessary training relevant to their duties to maximize operational efficiency using all resources available. Evaluates performance of staff on a timely basis, providing feedback in the most constructive manner. Implements Plan or Improvement for deficiencies in meeting Medical Management performance goals. Works with directors and managers to develop processes to meet the guidelines for employee ratio to work volume Team Building. Encourages Medical Management staff to develop skills and knowledge for personal growth and promotion of position. Fosters leadership skills for supervisor positions to ensure most qualified staff performs management of processes. Promotes appropriateness in the utilization of staff by being flexible and assisting others when a staffing problem occurs. Identifies and helps develop future leadership candidates Education. Maintains a personal level of professionalism through attendance at required meetings and evaluates problematic issues using all resources for resolution. Cultivates relationships with medical groups and primary care physicians as well as all departments within the enterprise for customer development and knowledge sharing. Keep abreast of all new or revised policies and procedures when posted or distributed and is accountable for distributing information to all committees. Conduct one on one session when indicated to promote staff development of knowledge and resource information Planning and Future Development. Under the direction of the MM Committee, is responsible for maintaining a continuum in policy meeting national standards and health plan guidelines guaranteeing the effectiveness and success of the UM Program. Under the direction of Physician Advisory Committee, is responsible for development and management of clinical guidelines Customer Communication. Promotes communication to customers by informing them of updates and revision in MM policies using training or orientation opportunities, newsletters, or other available resources such as forum presentations. Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction Confidentiality. Respects customer and organizational confidentiality. Also respects the confidentiality of contractual arrangements and personnel issues of Medical Management staff Resource Management: Designs and implements programs to eliminate inappropriate use of medical resources. Uses all supplies and services in a resourceful and responsible manner. Budget Management: Responsible for planning the Medical Management SG&A and capital budget and all expenditures within the framework of the company budget. This responsibility includes the management of salaries, operating expenses, and Medical Management assets used for daily operations Delegation Oversight. Collaborates with Director of Delegation Management to ensure compliance with delegated requirements. Monitors monthly, quarterly and annual reporting according to delegation agreement and ensures annual assessments are conducted as applicable according to the delegation agreement, URAC, NCQA and CMS standards Reviews and analyzes all Management operational metrics, outcomes and utilization statistics. Identifies trends and patterns requiring intervention and process improvement. Responsible for implementation of UM, CM, DM and Quality work plans and annual program evaluations Other duties. Performs all other related duties as assigned

Youll 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: Bachelors of Science in Nursing or related degree required. (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelors degree) Active and unrestricted Registered Nurse license in any US state with the ability to obtain a Texas license within 12 months of starting employment Ten or more years of management-level utilization management experience in managed care with health plans required, including five or more years of experience at the Director level or above Experience in contract language, claims, UM management guidelines and accreditation guidelines Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

Preferred Qualifications: Masters degree in Nursing or Business Administration Fifteen or more years of experience in a managed care and/or disease/case/utilization management with ten or more years of management level experience

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity 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: Medicare, Medicaid, WellMed, Care management, Panhandle, TX Optum, UHG

Keywords: unitedhealthgroup, Lubbock , Associate Vice President, Care Management Operations - 933080 - Lubbock - 79416, Other , Lubbock, Texas