Care Management Administrator - Remote in Idaho

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 to start Caring. Connecting. Growing together.

The Care Management Administrator provides leadership and oversight to and is accountable for the day-to-day functioning of the care management program. Because of the unique structure and alignment of clinical programs within United Healthcare, the role requires a high degree of coordination with external and internal business partners, including, but not limited to the Inpatient and Intake/Prior Authorizations, Appeals and Grievance, Quality, Optum case and disease management, Optum Behavioral Health, state Medicaid partners and other clinical specialty, external vendors or national programs. A people leader, this position will lead a care team of managers and care coordinators.

The Care Management Administrator must work collaboratively with other Health Plan staff to support member care and achievement of state quality initiatives, HEDIS measures and to ensure compliance with relevant requirements of the state’s annual Performance Review(S) conducted by the External Quality Review Organization (EQRO), state or other oversight body and meeting NCQA requirements.

This is an Idaho-based position and you’ll enjoy the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Supports the development of an integrated Medicare-Medicaid and LTSS program to meet the needs of Idaho MMCP and IMPlus members and ensure UnitedHealthcare’s operations are aligned across all functional areas
• Leads, coaches/develops, trains (in conjunction with clinical learning team) and supports health plan based clinical team
• Ensures effective, compliant, clinical program delivery, monitors performance and clinical outcomes
• Contributes to the development and execution of overall health plan strategies through active participation in Health Plan Operations and Functional Area meetings
• May serve on various Health Plan Committees. May report clinical metrics and reports into quality and provider committees. Assist in development and maintenance of LTSS UM/CM annual work plan, program description, and program evaluations
• Implement innovative member engagement, clinical programs and affordability strategies for the integrated Medicare-Medicaid and LTSS program
• Develops strategies internally and with business partners for clinical management during high volume provider termination, new membership growth/expansion–ensuring member continuity of care and transition of care needs are met according to contractual requirements
• Supports Health Services Director in executing on change management strategies. Serves as resource to support all clinical teams in implementing contractual requirements and internal business changes.
• Conducts regular staff meetings with local Health Services staff and service partners as appropriate, to exchange corporate and health plan information/updates and address staff questions and concerns, etc.
• Serve as a leader for the health plan including direct leadership of a team consisting of care management managers and care coordinators
• Escalates clinical or other performance issues to Health Services Director as needed if unable to affect change locally
• Serve as a SME for the Health Plan’s LTSS population
• Oversees State specific clinical functions to ensure compliance with State regulatory requirements and works collaboratively with the Clinical Adherence team to ensure adherence with regulatory and contractual requirements.
• Understands the clinical services for Medicaid and Medicare line of business and/or cohorts contracted within the health plan
• Manage contractual compliance in relevant areas and identifies and addresses any contractual risks early
• Assists in the development and implementation with business partners, of health plan specific policies & SOPs to support care management strategies and contractual requirements, CM interventions, and administrative functions and ensures regular review and maintenance processes are in place. Utilizes national policies, procedures, SOPs as the basis for developing or adapting for state specific requirements. Ensure adoption and delivery of nationally approved policies, procedures, guidelines and standards for health plan based clinical staff and (and business partners). Conducts local clinical documentation reviews and monitoring to ensure compliance with requirements.
• Attends Clinical Governance Leadership meetings- monitor reports for outcomes and alignment with health plan targets and regulatory compliance
• Promotes ease of use of the Interdisciplinary Care Team review process so it is used by clinical staff to address member complex issues, conduct secondary review process for LTSS and/or HCBS care plans and address barriers to service delivery and ability of member to achieve goals
• Works in partnership with local compliance to support Medicaid and Medicare (if appropriate) Fair Hearing and SAP Process
• Provides input, as requested by the State, at State-level meetings
• Assist in promptly resolves any contractual issues identified by UnitedHealthcare or IDHW that may arise
• Manages execution by delegating work to maximize productivity, exceed goals and improve performance
• Actively participates in community outreach and networking activities to develop support and community infrastructure to meet member needs, promote membership growth and retention
• Fosters/supports social responsibility activities within the Health Plan/UHG and local community
• Participates in member advisory boards as appropriate

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 license in the State of Idaho as one of the following: RN, LCSW, LCPC, LPC, or LMFT
• 3 years of experience in Medicare/Medicaid, at-risk managed care environment
• 3 years of experience in a senior leadership capacity - program or people leadership role/capacity (including performance management functions and clinical/care coordination supervision)
• 3 years of experience with Medicaid and/or Medicare populations
• Experience in strategic planning and development
• Intermediate computer skills - MS Office Suite
• Demonstrated track record of clinical program compliance, functional collaboration, and meeting program goals
• Demonstrated track record of leadership development
• Proven leadership skills in both internal and external environments, including creating and delivering persuasive presentations on complex topics to management and public groups
• Resident of Idaho

Preferred Qualifications:

• CCM Certified
• 3 years of experience working in a matrix organization
• Medicaid Managed Care Experience
• Field based case management program implementation and monitoring

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.