RN Manager Care Management Houston, TX WellMed

UnitedHealth Group
Published
November 4, 2020
Location
Houston, TX
Category
Job Type

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 life’s best
work.(sm)

The Manager of Case Management is responsible for facilitating communication and directing the operations of all Case Management programs in a defined market. The Manager leads the market staff on all activities related to medical management initiatives including changes in process, staffing or care delivery model. Additionally, the manager ensures compliance with all state / federal regulations and NCQA / URAC standards. The Manager collaborates with the Regional Director of Case Management, medical directors, PCPs, clinic and corporate medical management leadership on care coordination activities.

This manager
position will lead the Inpatient Acute Care Case Manager team and it will allow
you to telecommute/work from home. This position will include onsite
representation to acute and/or post-acute facilities as business needs. Up to
25% Travel.

 

The
office address is located at 4700
West Sam Houston Parkway Houston, Texas 77041.

Primary Responsibilities:
  • Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
  • Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS
  • Engages in Care Team forums / meetings to support care coordination activities between the market providers and the case management team
  • Plans, organizes and oversees staff to ensure timely completion of um determinations, discharge planning and case management assessments
  • Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
  • Adapts departmental plans and priorities to address business and operational challenges
  • Oversees the team’s daily staffing requirements to meet program standards
  • Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
  • Tracks and trends outcomes for potential improvements in the care management process. Creates monitors, evaluates and disseminates program and productivity reports weekly, monthly, and as needed
  • Interviews, hires, and retains staff to meet the needs of the department
  • Evaluates staff performance and recommend merit increases, promotions, and disciplinary actions
  • Attends, and assists with the facilitation of local market intra-disciplinary care team meetings
  • Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
  • Monitors appropriate utilization of resources, overtime, supplies and mileage. The information listed above is not comprehensive of all duties / responsibilities performed
  • Perform comprehensive assessments and document findings in a concise / comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Performs all other related duties as assigned
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.
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