Case Manager - Manager- Remote in MA

Senior Care Options Plan Leadership

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UnitedHealthcare Community & State Senior Care Options Plan is a Fully Integrated Dual-Special Needs Plan (FIDE-SNP) serving dually eligible individuals in the Commonwealth of Massachusetts aged 65 or greater. This position reports to the Health Services Director in the Health Services Department within the Senior Care Options Plan. This position sets team direction, resolves problems and provides direction to nurse case managers. This position adapts departmental plans and priorities to address business and operational challenges such as staffing, the clinical model and inter-departmental actions and goals. 10% of expected travel within Massachusetts. If you reside near Worcester, MA, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

Leadership:

• Supervises a team that varies in size based upon capacity plans and staffing models. Direct reports are located at same site, at home or at a remote UHC site
• Hires, manages and develops new employees and proactively monitors individual and team performance by providing frequent, ongoing feedback and coaching
• Implements strategies to improve operational performance, quality and delivery service to constituents
• Leads regular team meetings to communicate changes, relevant operational performance information and/or to build employee engagement
• Utilizes Our United Culture concepts and tools and delivers on the commitments
• Demonstrates a positive leadership shadow by shaping positive behaviors in areas of influence, building integrity, influencing our values and creating a healthy, high-performance environment

Drive Effective Clinical Decisions within a Business Environment:

• Develops and/or implements bottoms-up strategies to improve operational performance
• Continually stays abreast of operational performance, identifies degradation in service levels and leads to remediation of issues
• Responsible for the interview and selection decisions on new hire staffing within their own hierarchy
• Accountable for a successful new hire onboarding experience
• Responsible for creating a positive and meaningful onboarding experience for all employees
• Delivers and documents one-on-one coaching to improve all aspects of performance and effectiveness
• Completes "side-by-side" monitoring/coaching with direct reports on a regular basis
• As needed, prepares, delivers and manages remediation plans
• Participate in job fairs, open houses and other recruitment events as needed
• Ensure compliance with Model of Care and State contractual requirements (Chart audits)
• Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results
• Use appropriate business metrics (e.g. member/FTE, length of stay, readmission rates, STAR ratings, member engagement rates) and applicable processes/tools (e.g. cost benefit analysis, return on investment, performance, staffing calculator) to optimize decisions and clinical outcomes
• Prioritize work based on business algorithms and established work processes, or in their absence, identify business priorities and build consensus to triage and deliver work (e.g. assessments, case/claim loads, previous hospitalizations, acuity, morbidity rates, quality of care follow up)
• Understand and operate effectively/efficiently within legal/regulatory requirements (e.g., HIPAA, CMS, State)

Coaching & Performance Management:

• Communicate with direct reports on a regular basis through coaching sessions and by providing timely, actionable feedback
• Ensures performance metrics and goals are reviewed on a regular and frequent basis, with time set aside for incidental issues
• Provides purposeful and actionable development feedback to direct reports and monitors to support their performance improvement
• If, after the action items of the development plan do not yield the desired positive results in the agreed upon timeframe, CAP is initiated in accordance with UHG policies and practices
• Works with HRdirect on disciplinary actions or terminations and seeks manager approval on all terminations
• Tracks and manages attendance and punctuality in a timely and accurate manner

Development & Employee Engagement:

• Prepares and delivers thorough and meaningful performance discussions and documents with data and fact-based examples to reduce ambiguity of ongoing expectations
• Creates purposeful and actionable development plans, reviews with employees and monitors to support their performance improvement expectations and development
• Engages in regular, meaningful and candid development and career discussions with direct reports
• Guides employees to leverage available training and development resources
• Analyzes and understands employee experience survey results and communicates results to team members
• Works to establish an action plan to address opportunity areas and improve results
• Supports overall organization in employee engagement programs and communications

Communication:

• Holds consistent 1:1 meetings with direct reports
• Regularly leverages various communication channels, including one-on-ones and new hire class leadership interactions to foster two-way communication
• Inspires employees to see the link between their position and personal performance to organizational strategy, company performance and the UHC brand

Demonstrate Business and Industry Knowledge:

• Demonstrate knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
• Demonstrate knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid,) or regulatory bodies (e.g., EOHHS, HIPAA, Milliman)
• Demonstrate understanding of relevant health care benefit plans
• Demonstrate knowledge of applicable area of clinical specialization
• Utilize resources to enhance professional practice and development based on learning gaps or new information

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Unrestricted nursing license in the state of MA
• 5+ years of care management experience and/or 5+ years of equivalent clinical knowledge and experience such as social care, healthcare coordination, quality improvement
• 1+ years of experience with SharePoint and shared network drives
• Intermediate level of proficiency with Microsoft Office applications, including Word, Excel and PowerPoint
• Access to reliable transportation and valid US driver's license

Preferred Qualifications:

• BS/BA degree
• 3+ years of leadership experience
• Proven ability to focus activities on a strategic direction and achieve targets
• Time management and prioritization skills
• Strong written and verbal professional communication skills
• Excellent team development skills
• Strong interpersonal skills
• Ability to work in a self-directed manner in a fast-paced, rapidly changing environment
• Demonstrated leadership abilities

All telecommuters 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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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