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Manager, Care Management - Winter Park, FL (RN & CCM)

UnitedHealth Group

Winter Park, FL
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Job Details

746278 Manager Care Management Winter Park FL

Manager, Care Management - Winter Park, FL (RN & CCM) (746278)

Position 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)

*This position is located at 1555 Howell Branch Road, Winter Park, Florida 32789 and M-F from 8am-5pm.*


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 ensures 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 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, and 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 recommends 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
  • Performs comprehensive assessments and documents 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

Required Qualifications:

  • Bachelor of Science in Nursing (BSN); Four additional years of experience beyond the required years of experience may be substituted in lieu of a Bachelor's degree
  • Current unrestricted RN license in the applicable state
  • CCM certification or proof that certification has been obtained within one year of hire date
  • 5 years of healthcare experience; To include experience in a managed care setting, hospital setting. and/or physician practice setting
  • 3+years of demonstrated supervisory or management experience, with responsibility for team performance management
  • Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians, and other members of senior administration, as well as the general public
  • Data mining, analytical, and reporting skills; Must be able to review and interpret data to make recommendations to senior-management
  • Availability for in and /or out-of-town travel, as deemed necessary by business need
  • Solid experience with MS Office, including Word, Excel, and Outlook, with proficient ability to navigate in a Windows environment
  • Strong organizational skills and multitasking abilities

Preferred Qualifications:

  • Master's of Science in Nursing
  • Prior multi-site regional operations management responsibility

Physical and Mental Requirements:

  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem-solving

If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.


Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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.



Job Keywords: Excel, case management, social worker, registered nurse, RN, CCM, manager, supervisor, Winter Park, Orlando, Kissimmee, Windermere, Edgewood, FL, Florida

Job Details

  • Contest Number746278
  • Job TitleManager, Care Management - Winter Park, FL (RN & CCM)
  • Job FamilyNursing
  • Business SegmentOptumCare

Job Location Information

  • Winter Park, FL
    United States
    North America
  • Other LocationsWindermere-Florida, FL
    Edgewood-Florida, FL
    Orlando, FL
    Kissimmee, FL

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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