Manager, Clinical Oversight and Monitoring

Manager
United Health Group
United States, Houston
Mar 2012
This job posting expired on April 30, 2012.
UnitedHealthcare Community Plan is searching for a Manager of Clinical Oversight and Monitoring. This role will be primarily responsible for monitoring changes with laws, regulations, contractual obligations, internal policies and procedures to ensure clinical operations adherence with guidelines and requirements. Daily responsibilities include :

· Supervises team of Clinical Oversight & Monitoring consultants (4) in execution and delivery of Clinical Monitoring and Oversight Program for various TX community health plans
· Manages the delivery of Oversight and Monitoring of all Clinical Programs (Utilization Management, Case Management/Service Coordination and Disease Management) for the Health Plan(s) for the State of Texas
· Ensures local clinical processes, policies and procedures meet regulatory/NCQA/CMS standards and are consistent with State and Federal guidelines and national policy
· Administers clinical quality monitoring and oversight of clinical programs/staff to meet defined goals/targets, contract requirements
· Collaborates with cross-functional teams, shared services, and health plan management to provide contractual oversight of a health services department with the objectives of ensuring contractual obligations and policy are met for members in a range of products, i.e., Medicaid, CHIP, SSI/ABD, long term care, and dually eligible categories, improving cost efficiencies, and developing an environment of operational excellence
· Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations
· Assist in the development of and utilize timely and meaningful monitoring reports to assess Health Services performance
· Proactively develops and implements staff retention and engagement program
· Communicates best practices, barriers and potential solutions when operational processes or clinical programs are not delivering results
Qualifications
- Current, unrestricted RN licensure in TX required
- Minimum 3 years experience in a leadership or managerial role with direct reports is required
- 5+ years experience in development, execution and oversight of clinical programs (CM/UM/DM) preferrably in public sector managed care environment
- 2+ years clinical experience with Medicaid/Medicare populations required
- 5+ years of experience working in a government or healthcare environment with hands-on experience directly within compliance required
- 2+ years experience in Long term care, Utilization Management, Case Management, Clinical Compliance or Quality required
- Experience with Government Healthplans (Medicaid, Medicare, CHIP)
- Bachelors in Nursing is highly preferred


UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Reference number: 376292