52 Care Management jobs in Richmond Highlands
Associate Patient Care Coordinator - Shoreline, WA
Posted 9 days ago
Job Viewed
Job Description
The **Associate Patient Care Coordinator (Primary Care/Specialty)** is responsible for the completion of set processes and protocols. Works cooperatively with all members of the care team to support the vision and mission of the organization, deliver excellent customer service, and adhere to Lean processes. Supports the teams in meeting financial, clinical, and service goals.
**Schedule (32 hours):** Flexibility required to work during clinic/business hours: Monday-Friday 7am-7pm, Saturday & Sunday 8am-5pm PST. Schedule to be determined by supervisor upon hire.
**Location** : 1201 N 175th St. Shoreline, WA 98133
**Primary Responsibilities:**
+ First point of contact for our patients. Sets the tone for a positive experience
+ Exhibits empathy, courtesy, competence, efficiency, and care
+ Schedule appointments and procedures, following standard guidelines
+ Uses Multiple computer and phone systems to fulfill patient needs over phone
+ Verifies patient information, while documenting in their Electronic Health Record (EPIC)
+ Advises patients of their responsibilities regarding insurance and referral information
**What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:**
+ Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
+ Medical Plan options along with participation in a Health Spending Account or a Health Saving account
+ Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
+ 401(k) Savings Plan, Employee Stock Purchase Plan
+ Education Reimbursement
+ Employee Discounts
+ Employee Assistance Program
+ Employee Referral Bonus Program
+ Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
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:**
+ High School Diploma/GED (or higher)
+ 1+ years of customer service experience
+ 1+ years of basic computer software experience
**Preferred Qualifications:**
+ 1+ years of receptionist experience in a medical office
+ 1+ years of experience in a healthcare setting
+ Excellent communication skills and phone etiquette
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 hourly pay for this role will range from $16.00 to $27.69 per hour 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, 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._
#RPO #RED
Care Management Coordinator
Posted today
Job Viewed
Job Description
The Care Management Coordinator provides essential clerical support for the Care Management Department. Under the supervision of licensed clinical staff, accountabilities include coordinating communication between patients, health care providers, ins Management, Coordinator, Healthcare
Director Care Management, Medicaid
Posted 1 day ago
Job Viewed
Job Description
Who we are
Community Health Plan of Washington is
an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:
- Strive to apply an equity lens to all our work.
- Reduce health disparities.
- Become an anti-racist organization.
- Create an equitable work environment.
Responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for assigned lines of business. These activities include proactive identification of members in need of care management services, application of case management for identified members, care coordination and condition-specific management for certain populations with an emphasis on equity. The focus is on supporting access to medically necessary and high quality of care and efficient utilization of available healthcare resources, facilities and services and collaboration with community programs and agencies for effective utilization of social services in the community. This role encompasses the effective and efficient management of human, fiscal and other resources, development of staff competency through assessment and education, compliance with regulatory and professional standards and strategic planning, improvement of quality, service levels, safety, customer satisfaction and of collaborative relationships within CHPW and CHNW.
To be successful in this role, you:
- Have a bachelor's degree in Nursing or a master's degree in social work and/or a relevant health field, required
- Have a master's degree in Nursing, Healthcare Administration, Public Health, or Business strongly preferred
- Have a current, unrestricted license in the State of Washington as an RN required, if applicable
- Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) required, if applicable
- Have a certification as a Case Manager, required
- As this position involves traveling on behalf of the Company, a current driver's license and an acceptable driving record is required
- A minimum of seven (7) years progressively responsible management experience in the areas of case management, population health and/or disease management required, including a minimum of five (5) years progressive experience working with medical and behavioral case management required
- Designs and implements systematic and comprehensive care management policies and procedures that ensure high quality care management application to positively impact member outcomes.
- Administers and ensures care management programs meet compliance and regulatory standards as required by Centers for Medicare & Medicaid Services (CMS), DSNP Model of Care (MOC), Washington Health Care Authority (HCA), and/or National Committee on Quality Assurance (NCQA) for continued accreditation of the health plan, as well as state and federal regulations, quality metrics and evolving models of care.
- Provides oversight of programs within assigned lines of business including development, implementation of program components, quality data collection and monitoring, auditing of program requirements and reporting outcomes to appropriate leadership and committees.
- Responsible for a strong understanding of health plan benefits for all lines of business.
- Defines strategy to identify and assess outlying and high-risk cases to determine plan of care.
- Develops and designs procedures, processes, productivity targets, quality of care and financial goals, and new delivery models for medical and behavioral health care management.
- Collaborates with Medical Directors, Healthcare Analytics, Network Management and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues. Uses data to guide the development and implementation of health care interventions that improve value to the member.
- Collaborates with internal leaders to deploy a coordinated regional approach to member and provider services in each region across the state.
- Drives strategy for the development, reporting, monitoring, and analysis of department measures that are linked to organizational goals especially as pertains to achieving enrollment targets in care management programs and return on investment projections on care management programs.
- Works collaboratively with other members of the Clinical Services Leadership Team to establish mechanisms and processes to regularly analyze the different Plan populations for variances in clinical and service quality to identify and recommend the highest impact opportunities and department-level strategies for interventions.
- Delegates responsibilities to managers and provides professional development opportunities for team leaders.
- Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for clinical teams. Aligns team goals with the organization's vision and strategy.
- Evaluates and integrates Community Health Center processes and programs to ensure that resources are being maximized to improve member care and reduce duplication of work within CHPW.
- Responsible for ensuring the day-to-day supervision of divisional staff including identifying staffing and resource needs, effective hiring, appropriate performance management, staff development, with the goal of developing a cohesive, empowered, and productive work environment.
- Responsible for annual budget preparation and monitoring expenses within the department.
- Participates and/or Chairs/Co-Chairs on committees as assigned
- Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
- Other duties as assigned; essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
- Experience with designing and deploying new programs and teams.
- Demonstrated ability to effectively lead and manage large staffs, including the ability to achieve results through others.
- Experience with identifying, testing and implementing innovative concepts that support special population needs.
- Knowledge of the various components of managed care (quality improvement, disease management, population management, utilization management, and case management) and how they link.
- Actively uses and supports quality improvement principles and methods in an effort to improve inter- and intra-departmental processes.
- Strong project management skills, including the ability to implement new programs and products.
- Excellent 'customer service' attitude in relationships with enrollees/patients, staff and external partners.
- Highly effective communicator orally and in writing, with the ability to translate strategy into action.
- Fosters an effective work environment and ensures employees receive recognition, feedback and development.
- Ability to relate and interact with staff at all levels of the organization; exercises sound judgment, builds strong working relationships and demonstrates diplomacy, professionalism, and appropriate confidentiality in dealing with others.
- Strong analytical and problem-solving skills.
- Articulates organizational vision and implements strategic initiatives, with the ability to identify systemic issues to promote real change.
- Working knowledge of M/S office (Word, Excel, Access)
- Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA).
- Perform all functions of the job with accuracy, attention to detail and within established timeframes.
As part of our hiring process, the following criteria must be met:
- Complete and successfully pass a criminal background check.
- Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
- Vaccination requirement (CHPW offers a process for medical or religious exemptions)
- Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
The position is FLSA Exempt and is not eligible for overtime and has a 15% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match
- Employee Assistance Program and Mental Fitness app
- Financial Coaching, Identity Theft Protection
- Time off including PTO accrual starting at 17 days per year.
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty
Sensory* :
- Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
- Physical* : Extended periods of sitting, computer use, talking and possibly standing
- Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
- Frequent torso/back static position; occasional stooping, bending, and twisting.
- Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.
- Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.
Work Environment:
Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Care Management Support Coordinator II
Posted today
Job Viewed
Job Description
Immediate need for a talented Care Management Support Coordinator II . This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote- PST). Please review the job description below and contact me ASAP if you are interested. Job ID:25-75812 Pay Range: $22 - $23/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Schedule: 7 am - 4 pm PST/8 am - 5 pm PST. Needs to be available for weekend work as needed. OT not required. Peer to peer phone scheduling team. Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service. Ability to work from home, fast paced work environment, working cross-functionally with MD and clinical team., improving provider experience, and helping ensure that member's receive needed services. Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service. May apply working knowledge of assigned health plan(s) activities and resources. Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols. Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship. Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed. Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs. Performs other duties as assigned. Complies with all policies and standards.Key Requirements and Technology Experience: Key Skills: Scheduling ,HealthCare ,Call Center . Critical thinking skills, takes feedback well, adaptability. Scheduling experience Microsoft Outlook Call Center Experience Healthcare Background Strong verbal and written skills previous p2p experience Avg call handle time 7.5 min, avg hold time 1.5 min, calls are audited for quality, 90% service levels. 100% - 95% audit scores, 20-40 calls/day. Requires a High School diploma or GED Requires 1 - 2 years of related experience.Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.#prof
Inpatient Care Management Medical Director - Remote
Posted 5 days ago
Job Viewed
Job Description
We are currently seeking an **Inpatient Care Management Medical Director** to join our Optum team. This team is responsible for conducting acute level of care and length of stay reviews for medical necessity for our members being managed within the continuum of care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses
+ Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectations
+ Is grounded in the use and application of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review
+ Occasionally, may participate in periodic market oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers
+ Maintain proficiency in all required software and platforms
Although the United Health Services ICM Medical Director's work is typically concentrated in a region, they are part of a national organization and team, and collaborate with peers, nurse managers, and non-clinical employees from across the country. In response to customer needs and expectations, Optum is continuously modifying its programs and approaches. Although not a primary job function, Medical Directors with the interest in doing so often can be involved with change design and management.
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:**
+ MD or DO with an active, unrestricted medical license
+ Current Board Certification in an ABMS or AOBMS specialty
+ 3+ years of clinical practice experience post residency
+ Private home office and access to high-speed Internet
+ Technical proficiency in computer software and systems
**Preferred Qualifications:**
+ Licensure in either HI, AK, OR, ID, WA, UT a plus
+ 2+ years of managed care, Quality Management experience and/or administrative leadership experience
+ Prior UM experience
+ Clinical experience within the past 2 years
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
**California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only:** The salary range for this role is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
**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._
_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._
Inpatient Care Management Medical Director - Remote
Posted 9 days ago
Job Viewed
Job Description
We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting acute level of care and length of stay reviews for medical necessity for our members being managed within the continuum of care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses
+ Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and customer level to address customer expectations
+ Is grounded in the use and application of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review
+ Occasionally, may participate in periodic market oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers
+ Maintain proficiency in all required software and platforms
Although the Optum ICM Medical Director's work is typically concentrated in a region, they are part of a national organization and team, and collaborate with peers, nurse managers, and non-clinical employees from across the country. In response to customer needs and expectations, Optum is continuously modifying its programs and approaches. Although not a primary job function, Medical Directors with the interest in doing so often can be involved with change design and management.
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:**
+ MD or DO with an active, unrestricted medical license
+ Current Board Certification in an ABMS or AOA specialty
+ 3+ years of clinical practice experience post residency
+ Technical proficiency in computer software and systems
+ Private home office and access to high-speed Internet
+ Participate in rotational holiday and call coverage
**Preferred Qualifications:**
+ 2+ years of managed care, Quality Management experience and/or administrative leadership experience
+ Prior UM experience
+ Clinical experience within the past 2 years
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
The salary range for this role is $238,000 to $357,500 per year. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
**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._
Medical Director - Post-Acute Care Management - Care Transitions - Remote
Posted today
Job Viewed
Job Description
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Care Transitions (naviHealth) product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home. We're connecting care to create a seamless health journey for patients across care settings. Join us to start **Caring. Connecting. Growing together.** **Why Care Transitions?** At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Provide daily utilization oversight and external communication with network physicians and hospitals + Daily UM reviews - authorizations and denial reviews + Conduct peer to peer conversations for the clinical case reviews, as needed + Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care + Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services + Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers + Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders + Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers + Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals + Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees + Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting + Regularly meet with Care Transitions' leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues + Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions' products and services + Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME + Participate on the Medical Advisory Board + Providing intermittent, scheduled weekend and evening coverage + Perform other duties and responsibilities as required, assigned, or requested 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:** + Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willing to maintain necessary credentials to retain the position + Current, unrestricted medical license and the ability to obtain licensure in multiple states + 3+ years of post-residency patient care, preferably in inpatient or post-acute setting **Preferred Qualifications:** + Licensure in multiple states + Willing to obtain additional state licenses, with Optum's support + Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care + Demonstrated ability to work within a team environment while completing multiple tasks simultaneously + Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision + Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals + Demonstrated competence in use of electronic health records as well as associated technology and applications + Proven excellent organizational, analytical, verbal and written communication skills + Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues + Proven highest level of ethics and integrity + Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $238,000 to $357, 500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **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._
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Medical Director - Post-Acute Care Management - Care Transitions - Remote
Posted 9 days ago
Job Viewed
Job Description
As a team member of our Care Transitions (naviHealth) product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.
We're connecting care to create a seamless health journey for patients across care settings. Join us to start **Caring. Connecting. Growing together.**
**Why Care Transitions?**
At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Provide daily utilization oversight and external communication with network physicians and hospitals
+ Daily UM reviews - authorizations and denial reviews
+ Conduct peer to peer conversations for the clinical case reviews, as needed
+ Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
+ Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services
+ Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
+ Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
+ Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
+ Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
+ Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
+ Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
+ Regularly meet with Care Transitions' leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
+ Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions' products and services
+ Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
+ Participate on the Medical Advisory Board
+ Providing intermittent, scheduled weekend and evening coverage
+ Perform other duties and responsibilities as required, assigned, or requested
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:**
+ Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willing to maintain necessary credentials to retain the position
+ Current, unrestricted medical license and the ability to obtain licensure in multiple states
+ 3+ years of post-residency patient care, preferably in inpatient or post-acute setting
**Preferred Qualifications:**
+ Licensure in multiple states
+ Willing to obtain additional state licenses, with Optum's support
+ Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care
+ Demonstrated ability to work within a team environment while completing multiple tasks simultaneously
+ Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
+ Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
+ Demonstrated competence in use of electronic health records as well as associated technology and applications
+ Proven excellent organizational, analytical, verbal and written communication skills
+ Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues
+ Proven highest level of ethics and integrity
+ Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
The salary range for this role is $238,000 to $357, 500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
**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._
Medical Director - Post-Acute Care Management - Care Transitions - Remote
Posted 9 days ago
Job Viewed
Job Description
Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 5 industry leader.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Work to improve quality and promote evidence-based medicine
+ Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement
+ Support initiatives that enhance quality throughout our national network
+ Ensure the right service is provided at the right time for each member
+ Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review
Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting.
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:**
+ MD or DO degree
+ Active, unrestricted physician state license
+ Current board certification in ABMS or AOA specialty
+ 5+ years of clinical practice experience post residency
+ Solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles
**Preferred Qualifications:**
+ Hands-on utilization and/or quality management experience
+ Project management or active project participation experience
+ Substantial experience in using electronic clinical systems
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
The salary range for this role is $238,000 to $357, 500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
**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._