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Manager, Medical Clinical Operations – Southwestern PA or DE

UnitedHealth Group

Pittsburgh, PA
Job Code:
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Job Details

Manager, Medical Clinical Operations – Southwestern PA or DE(Job Number:716747)

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 has responsibility for oversight of all Care Management (CM) Operations including management of staff, compliance with regulatory audits, management of state based initiatives, adherence to NCQA / HEDIS measures and all administrative services to assure the ongoing work of Optum CM.
This is a work at home position with field - based travel required throughout the state of Pennsylvania or Delaware.
Primary Responsibilities:
  • Manages and is accountable for professional employees and / or supervisors
  • Sets team direction, resolves problems and provides guidance to members of own team
  • Participates in supervised field visits with the Community Health Workers
  • Adapts departmental plans and priorities to address business and operational challenges
  • Influences or provides input to forecasting and planning activities
  • Monitors, manages and controls operational and performance metrics in conjunction with established program value targets
  • Develops solutions to address new, often complex customer requirements that address operational, clinical and customer needs
  • Ensures audits are conducted timely, standards are met, and successful outcomes are achieved
  • Reviews operational and performance metrics regularly and drives action plan development and execution
  • Ensures site remains compliant with all applicable regulatory and accreditation requirements (NCQA and URAC)
  • Collaborates across Optum and UHG and interacts with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders

Job Med & Clin Ops-General Mgmt
Primary Location US-PA-Pittsburgh
Other Location US-Delaware
Organization Optum Ops-PHM Medicaid
Schedule Full-time
Number of Openings 2
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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