Shire Jobs

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.

Responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). This includes case management, coordination of care, problem-solving at the member, family, and provider level and medical management consulting. Function may also be responsible for providing health education, coaching, review/approval of service plans and leading projects.

Administratively responsible for the organizational development of the Health Services/Case Management function, in a region with extensive geographic coverage. Utilizing the principles of continuous quality improvement, the Director of Case Management provides leadership, administrative and management support, strategic planning, and overall direction of the region’s Health Services/Case Management functions. Accountability for the profitability of the region’s as impacted by medical expenses and trend. Responsible for the execution of all Clinical Programs in a region designed to manage medical expense. Promotes a positive public image, facilitates the establishment of effective and efficient internal and external customer interfaces and ensures development of staff through the implementation of logically developed goals, objectives and strategic plans.

If you are located in Southern Arizona, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges. Travel is required.

Primary Responsibilities:

• Excellent Communication skills and ability to interrelate with individuals at various level and in various functional areas throughout the organization and to develop effective business relationships

• Responsible for working collaboratively with providers, as well as with internal plan management and Medical Directors in setting direction and strategic planning to develop, implement and monitor action plans to modify care delivery patterns and reduce expenses

• Develops annual goals and objectives to achieve appropriate reductions in medical expenses that correlate with continuous performance and quality of care improvement efforts

• Identify, select, structure, and prioritize process improvement projects and revises to meet changing needs and requirements

• Follow up with workgroup team members as appropriate

• Lead one or more projects across internal and or external divisions or areas

• Participates in program development/initiative workgroups within UnitedHealth Group

• Oversees regional teams of case management managerial staff, serves as a mentor, monitors adherence to state contract requirements and performance measure outcomes

• Serves as the key Health Services/Case Management resource and consultant to internal and external customers. Forms strategic relationships which will support program growth, expansion and the development of new models/programs

• Leads and develops staff in areas of personal growth. Responsible for guiding development of multiple levels of professional staff while serving as a role model, teacher, coach and leader

• Communicates departmental and corporate goals and engages everyone in their achievement

• Creates a team oriented management environment, enhancing the integration between the clinical and operations sections of medical affairs

• Manages mentors and supports staff in designated department or region. Develops clear goals and objectives for performance management and effectively communicate accountability

• Assists with design and implementation of global and regional medical affairs initiatives

• Assists in strategic development of medical affairs processes to ensure that efficient and systematic operational plans are created and executed

• Ensures standardized execution of workflow processes, such as authorizations and non-certifications and analyze outcomes of standardized audits for AHCCCS, NCQA and HEIDIS purposes

• Acts as regional interface with other departments to coordinate workflow processes and implementation plans

• Assists in the development and execution of educational programs to enhance staff development

• Conduct thorough reviews of state policies requirements and updates to ensure compliance with the plan's procedures, helping to develop strategies address identified gaps

• Develop and update procedures as assigned to provide clear direction for staff to maintain compliance with internal and external contract and policy requirements

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:

• Registered nurse or LPN with a current AZ license or degreed Social Worker or who has a degree in Psychology, Special Education, or counseling or degree in similar field

• 3+ or more years working in a supervisory role in programs for persons that are elderly, seriously mentally ill or have developmental disabilities

• Supervisory and training experience

• Proven basic knowledge of Medicare/Medicaid regulations

• Ability to perform in a leadership role and regularly exercise independent judgment and discretion in handling of duties

• Demonstrated working knowledge of Microsoft Word, Excel, and PowerPoint

• Proven solid written/grammar and communication skills, excellent time management skills, the ability to master new skills and ideas, able to adapt to change, and exhibit flexibility

• Demonstrated first rate customer service, interpersonal skills, detail oriented and self-motivation

• Ability to exhibit original thinking and creativity in the development of new and improved methods and approaches to problems

• Ability to function independently and responsibly with minimal need for supervision

• Ability to demonstrate initiative in achieving individual, team, and organizational goals and objectives

• Proven computer efficiency

• Ability to be an effective team player

• Proven solid organizational skills

• Ability to be flexible and able to meet short timelines

Preferred Qualifications:

• Long-term care, home health and managed care experience, and care coordination

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

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.