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Manager, Care Management for WellMed- Dallas, TX

UnitedHealth Group


Location:
Dallas, TX
Date:
03/30/2017
Job Code:
1724258
Apply on the Company Site
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Job Details


Manager, Care Management for WellMed- Dallas, TX(Job Number:704060)
Description

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)

 

The Manager of Case Management is responsible for facilitating communication and directing the operations of all Case Management programs in a defined market.  The Manager leads the market staff on all activities related to medical management initiatives including changes in process, staffing or care delivery model. Additionally, the manager ensures compliance with all state / federal regulations and NCQA / URAC standards.  The Manager collaborates with the Regional Director of Case Management, medical directors, PCPs, clinic and corporate medical management leadership on care coordination activities. 
 
Primary Responsibilities:
  • Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
  • Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS
  • Engages in Care Team forums / meetings  to support care coordination activities between the market providers and the case management team 
  • Plans, organizes and oversees staff to ensure timely completion of um determinations, discharge planning and case management assessments
  • Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
  • Adapts departmental plans and priorities to address business and operational challenges
  • Oversees the team’s daily staffing requirements to meet program standards
  • Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
  • Tracks and trends outcomes for potential improvements in the care management process.  Creates monitors, evaluates and disseminates program and productivity reports weekly, monthly, and as needed
  • Interviews, hires, and retains staff to meet the needs of the department
  • Evaluates staff performance and recommend merit increases, promotions, and disciplinary actions
  • Attends, and assists with the facilitation of local market  intra-disciplinary care team meetings
  • Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
  • Monitors appropriate utilization of resources, overtime, supplies and mileage
  • Perform comprehensive assessments and document findings in a concise / comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Performs all other related duties as assigned

Job Case Management
Primary Location US-TX-Dallas
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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