This position has responsibility for oversight of all CM operations including management of staff, compliance with audits, management of state based initiatives, adherence to NCQA / HEDIS measures and all administrative services to assure the ongoing work of Optum CM Virginia.
- Manages and is accountable for professional employees and / or supervisors
- Participates in "ride-along" / audits with the Community Health Workers during field visits with members
- Able to travel two to three times per month to meet with clients and direct reports in the field
- Sets team direction, resolves problems and provides guidance to members of own team
- Adapts departmental plans and priorities to address business and operational challenges
- Influences or provides input to forecasting and planning activities
- Monitors, manages and controls operational and performance metrics in conjunction with established program value targets
- Develops solutions to address new, often complex customer requirements that address operational, clinical and customer needs
- Ensures audits are conducted, standards are met, successful outcome are achieved
- Reviews operational and performance metrics regularly and drives action plan development and execution
- Ensures site remains compliance with all applicable regulatory and accreditation requirements (NCQA and URAC)
- Collaborates across OCHS and UHG including Medical, Site Directors, senior leaders, sales, account management, product organization, and other stakeholders
Licensed Social Worker, Licensed Mental Health Professional or Registered Nurse with a minimum of two (2) years of relevant Medicaid health care experience
Licenses must be Independent, unrestricted and in the state of Virginia
Minimum 2 years of Case Management experience
- Minimum 2 years of Leadership experience
- Minimum 2 years Behavioral Health experience
- Proficient in Microsoft Word, Excel and PowerPoint
- Must live within a commutable distance of Roanoke, VA
- Reliable transportation
- BSN if RN applicant
- Strong team building, leadership and mentoring skills
- Demonstrated ability with developing strategic plans, attainable goals, drive performance, and achieve targets
- Field based or Community based experience
- 3+ year previous supervisory or management experience (including performance management functions i.e. hiring, performance evaluations, corrective action plans, etc.)
- Experience working for an insurance company or other managed care setting
- Experience working with the Medicaid population
Ability to communicate with members who have complex medical needs and may have communication barriers.
Experience with vulnerable subpopulations including; children and youth with special health care needs, adults with serious mental illness, children with serious emotional disturbances, members with substance use disorders, children in foster care or adoption assistance, and members with other complex or multiple chronic conditions.
- Certified Case Manager (CCM)
- Experience with accreditation requirements (NCQA and URAC)
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.