UnitedHealth Group Manager Medical Clinical Operations - Registered Nurse preferred - Memphis or Nashville, TN - Telecommute in Memphis, Tennessee

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)

This position has responsibility for oversight of all CM operations including management of staff, compliance with audits, management of state based initiatives, adherence to various measures and all administrative services to assure the ongoing work of Optum CM Tennesse.

This is a work at home position and there will be some field-based travel on a quarterly basis.

If you are located in Nashville, TN or Memphis, TN area you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • 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 quarter 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

Required Qualifications:

  • 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 Tennessee

  • Minimum 2 years of Case Management experience

  • Minimum 2 years of Leadership experience

  • Proficient in Microsoft Word, Excel and PowerPoint

  • Must live within a commutable distance of Nashville or Memphis, TN

  • Reliable transportation

Preferred Qualifications:

  • 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)

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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: Licensed Social Worker, Licensed Mental Health Professional, Registered Nurse, Case Management, Medicaid, NCQA, URAC, Nashville, Memphis, TN, Tennessee, telecommute