Health Services Director - Remote in Nebraska

Requisition Number: 2351007
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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Health Services Director (HSD) is 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 and medical management consulting. The HSD may also be responsible for directing health education, coaching and treatment decision support for members. This Director will provide oversight and leadership to nurse clinicians responsible for the care management activities. The HSD must live in Nebraska.
If you reside in Nebraska, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

• Executes the delivery and governance of all Clinical Programs (Utilization Management, Care Management/Service Coordination and Disease Management) for the Health Plan
• Oversees the MCO's case management functions and ensures member's needs are met and policies/protocols comply with all state and federal requirement.
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
• Identifies and resolves technical, operational and organizational problems outside own team
• Product, service or process decisions with likely impact entire function and/or customer accounts (internal or external)
• Develops, translates and executes strategies or functional/operational objectives for a Health Plan clinical team including medical management, financial accountability, customer and Provider satisfaction, and quality assurance
• Work autonomously to identify issues, develop action plans and implement changes to positively impact business function
• Develops and implements the clinical program structure and resource plans that are consistent with National Clinical Model based on populations serviced by Health Plan
• Ensures local clinical processes, policies and procedures meet regulatory/NCQA/CMS/State of NE DHHS standards and are consistent with the national clinical model
• Leads, coaches, develops the clinical leadership staff and fosters innovation to improve member outcomes
• Identifies and drives local Healthcare Affordability Initiatives along with Medical Director and clinical team
• Ensures monitoring and oversight of clinical programs/staff to meet the defined goals/targets and contract requirements and to promote data driven development
• Uses data effectively to monitor and develop programs and processes to address areas of priority or opportunity
• Works collaboratively with providers, internal and external business partners, state departments, community based organizations, service contractors, and health plan management to oversee the management of a health services department with the objectives of improving the quality of care delivered to members in a range of products, i.e., Medicaid, CHIP, ABD and dual eligible categories, improving cost efficiencies and developing an environment of operational excellence
• Serves as the primary clinical contact for the State for inquires, State Fair Hearings, clinical state meetings, implementation of clinical programs and interfaces with other MCO's in market to collaborate on health services initiatives.
• Assists with development and support of medical home processes
• Identifies operational efficiencies to enhance operations, reduce operating costs, and standardize best practices across the organization
• Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations
• Collaborates with internal and external entities to improve accessibility standards and quality practice standards to reduce medical costs across the service delivery systems (inpatient, emergency departments, urgent care services and practitioner office settings)
• Utilizes timely, meaningful financial and utilization reports to assist providers in efforts to alter their care delivery patterns and improve member outcomes
• Develops and implements staff retention and engagement program and serves as the Health Plan Health Services SME and liaison with the state
• Ensures clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and clinical model standards

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:

• RN or LIMHP with current, unrestricted licensure in Nebraska
• 8+ years of clinical practice experience
• 4+ years of demonstrated management, leadership and team development experience
• 3+ years of experience in managed care Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements
• Experience working with government contracts and/or State agencies required
• Demonstrated ability to assist with focusing activities toward a strategic direction as well as developing tactical plans, drive performance and achieve targets
• Proven solid problem solving and analytic skills, with ability to draw relevant conclusions and devise appropriate courses of action
• Proven clear, concise presentation level communication skills and ability to convey complex or technical information in easily understandable terms; ability to interpret complex info from various sources
• Demonstrated track record of clinical program compliance
• Demonstrated ability to lead, influence and develop/mentor staff
• Proven adept in cross functional interactions, collaboration and meeting program goals
• Proven ability to influence in a matrix environment
• Proven excellent proficiency with MS PowerPoint, Excel, Word
• Resident of Nebraska
• Driver's License and access to a reliable transportation

Preferred Qualifications:

• Certified Case Manager
• Medicaid Managed Care Long Term Care Programs experience
• Field based case management program implementation and monitoring

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.