LVN/Licensed Vocational Nurse - Utilization Review - Remote - Kelsey Seybold Clinic 8
UnitedHealth Group
**
Washington, DC
Posted about 21 hours ago
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses.
Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston.
Be part of a team that is nationally recognized for delivering coordinated and accountable care.
As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties.
Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs.
Join us and discover the meaning behind Caring.
Connecting.
Growing together.
Primary Responsibilities:
• Perform documentation reviews to assess medical necessity and benefit correlation for requested medical and surgical procedures, services, and admissions for HMO, PPO, and POS products
• Serve as a facilitator of communication with the clinic, payor, and other customers
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:
• Licensed Vocational Nurse
• TX LVN license
• 2+ years of utilization review experience at a health plan, ACO, IPA, or provider group
• Ability to maintain CEU requirements
• Proven good organization and communication skills
• Proven HMO, PPO, and POS insurance knowledge
• Valid Driver's license
Preferred Qualifications:
• Computer and coding experience
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 $20.00 to $35.72 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.
OptumCare 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.
OptumCare is a drug-free workplace.
Candidates are required to pass a drug test before beginning employment.
Nurse Practitioner - Optum at Home - Washington, DC
UnitedHealth Group
**
Washington, DC
Posted about 21 hours ago
$20,000 Student Loan Repayment or $20,000 Sign-on Bonus for individuals who have not previously participated in this program.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 to start Caring. Connecting. Growing together. We're fast becoming the nation's largest employer of Nurse Practitioners; offering a superior professional environment and incredible opportunities to make a difference in the lives of patients. This growth is not only a testament to our model's success but the efforts, care, and commitment of our Nurse Practitioners. The Optum at Home (OAH) Dual Special Needs Plan (DSNP) program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of patients (beneficiaries) in their place of residence. The OAH program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, comprised of the Optum at Home team of clinicians as well as community-based health care professionals (e.g., PCP, specialists, behavioral health, pharmacy, and other providers). Optum providers serve people in their own homes through annual evaluations, longitudinal visits for higher risk beneficiaries, and care coordination during transitions from the hospital or nursing home and ongoing care management Nurse practitioners (NP) function in the role of the Advanced Practice Clinician (APC) within the Optum at Home, providing care to our highest-risk health plan beneficiaries. The APC is part of an interdisciplinary team that includes a Case Manager (RN and/or BHA), Care Navigator, Optum Pharmacy, and other supporting team members. APCs support all aspects of patient care, including diagnosis, treatments, and consultations. APCs provide general and preventative care, interventional care, point of care testing, patient/caretaker education, and medication prescribing during in-home, telephonic, and virtual visits with the interdisciplinary team. The APC is a licensed practitioner who works under a collaborative agreement (protocol) with a supervising physician (If applicable by State). The protocol is a written document in which the physician gives the NP authority to perform medical acts and agrees to be available for immediate consultation if necessary. The APC is responsible for managing health problems and coordinating health care for the Optum at Home beneficiaries in accordance with State and Federal rules and regulations and the nursing standards of care. This includes (but is not limited to) assessment of health status, diagnosis, development of plan of care, implementation of treatment plan, ongoing evaluation of patient status and response to the plan of care, and ordering drugs, treatments and diagnostic studies. Clinical management is conducted in collaboration with other care team members.This position will required 80-100% travel to patient homes/residences in the Washington, DC area all zip codes Primary Responsibilities:Perform comprehensive age-appropriate assessments for complex and chronically ill patients with the frequency established in the model of careEffectively manage medical and behavioral conditions, acute and chronic, in collaboration with the member's team of care providers (e.g., PCP, specialists)Ensure accurate and complete ICD 10 condition documentation with supportive evidence of diagnosis Provide acute, follow-up, and post-hospitalization evaluation to engage resources and strategies to address medical, functional, and social barriers to careDevelop a collaborative relationship with the team of health care providers, while acting as an advocate for the patient's goals of careOrder and interprets diagnostic tests relative to patient's age-specific needsPrescribe appropriate pharmacologic and non-pharmacologic treatment modalitiesImplement interventions to support goals to regain or maintain physiologic stability; monitoring the effectiveness of interventionsFacilitate the patient's transition within and between health care settings in collaboration with the primary care physician and other treating physiciansProvide patients and caregivers with counseling and education regarding health maintenance, disease prevention, condition trajectory, diagnosis, treatment, and need for follow up as appropriate during each patient visit.Conduct advanced illness and advanced care planning conversations to identify and prioritize the patient's goals of care for treatment plan developmentVerify and document that the patient understands diagnosis, treatment and follow up recommendationsActively participate in organizational quality initiatives, peer support, and mentoring activitiesParticipate in collaborative multidisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of service deliveryMaintain credentials essential for practice, to include licensure, certification, and CMEDemonstrate a commitment to the mission, core values and goals of UnitedHealthcare and its healthcare delivery including the ability to integrate values of compassion, integrity, performance, innovation and relationships in the care provided to our members 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:Graduate of an accredited Nurse Practitioner (NP) ProgramCurrent Advanced Practice Registered Nurse (APRN) Licensure with unrestricted license in good standing in Washington D.C.Board Certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC) or Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP) in addition to Adult/Family or Gerontology Nurse Practitioners (ACNP)Active Prescriptive Authority in the state of professional licensure (unless prohibited by state regulations)Solid computer skills, including Electronic Medical RecordAbility to travel 75-80% of time for field-based regional travel (This role requires you to travel from one appointment to the next. Should you be driving on your own, you must provide proof of a valid driver's license from appropriate government authorities, to ensure compliance with the law) Washington, DC area all zip codes Preferred Qualifications:2 years in practice (community or long-term care setting preferred)Experience in meeting the medical needs of patients with complex behavioral, social and/or functional needsAdvanced knowledge of and experience with symptom managementUnderstanding of Advanced Illness and end of life discussionsAwareness of health literacy and health equity in patient care settingsAbility to work with diverse care teams in a variety of settingsExperience working with patients in non-clinical settingsEffective time management and communication skills 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 re 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 salary for this role will range from $104,500 to $156,000 annually 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.vjm
Registered Nurse, RN
UnitedHealth Group
**
Atascocita, TX
Posted 2 months ago
Explore opportunities with Elite Home Health, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources.Primary Responsibilities:Clinical CompetenceInitiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionalsSupervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulationsProvides required supervisory visitsDocumentation and Care DeliveryProvides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team membersCompletes comprehensive assessments (OASIS) including medication reconciliation accurately and timelyDocuments patient visits per policy and payer requirements, and syncs timely per LHC policyQualityMakes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentationCommunicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other cliniciansCommunicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellenceTeamworkTakes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learningAssists in the orientation of new agency personnel and serves as a preceptor to other staff and studentsActively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomesParticipates in on-call and weekend rotation as needed to meet patient needsAdheres to and participates in the agency's utilization management model 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:Current and unrestricted RN licensure in state of practice1+ years of Home Health experienceCurrent Driver's License, vehicle insurance, and access to a dependable vehicle or public transportationCurrent CPR Certification Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: Ability to work independentlySolid communication, writing, and organizational skillsPay Range $64,100 - $141,500 annual total cash target pay$36.98 - $81.63 per visit point$30.82 - $68.03 hourly rateAnnual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of "direct" and "indirect" patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, 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.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.
Registered Nurse, RN
UnitedHealth Group
**
Atascocita, TX
Posted about 21 hours ago
Explore opportunities with Elite Home Health, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources.Primary Responsibilities:Clinical CompetenceInitiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionalsSupervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulationsProvides required supervisory visitsDocumentation and Care DeliveryProvides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team membersCompletes comprehensive assessments (OASIS) including medication reconciliation accurately and timelyDocuments patient visits per policy and payer requirements, and syncs timely per LHC policyQualityMakes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentationCommunicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other cliniciansCommunicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellenceTeamworkTakes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learningAssists in the orientation of new agency personnel and serves as a preceptor to other staff and studentsActively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomesParticipates in on-call and weekend rotation as needed to meet patient needsAdheres to and participates in the agency's utilization management model 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:Current and unrestricted RN licensure in state of practice1+ years of Home Health experienceCurrent Driver's License, vehicle insurance, and access to a dependable vehicle or public transportationCurrent CPR Certification Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: Ability to work independentlySolid communication, writing, and organizational skillsPay Range $64,100 - $141,500 annual total cash target pay$36.98 - $81.63 per visit point$30.82 - $68.03 hourly rateAnnual total cash compensation for this role assumes full-time employment (40 weekly hours) at full productivity and generally follows the range above. Total cash compensation includes earnings from per visit point pay and hourly pay and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. This role receives two types of compensation depending on the work being performed. When conducting visits, you will be paid per visit point rate compensation. Your per visit pay will be calculated by multiplying your per visit point rate by the productivity points you accrue for various types of visits. Each type of visit is assigned a certain number of productivity points that is inclusive of "direct" and "indirect" patient care activities. Visits are assigned based on patient and business needs. The number of visits performed each week will vary based on individual productivity targets and the productivity points assigned to the visits performed. You will be paid your hourly rate for certain non-visit activities such as orientation. We comply with all minimum wage laws as applicable. In addition to your pay, we offer benefits such as, a comprehensive benefits package, 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.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.
Social Worker - Manager of Case Management - Washington D.C. - Optum at Home
UnitedHealth Group
**
Martin's Additions, MD
Posted 2 months ago
**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 members access and navigate care anytime and anywhere.
As a team member of our Optum at Home product, together with an interdisciplinary care team we help members navigate the health care system and connect them to key support services. This preventive care can help members stay well 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.**
The Dual Special Needs Plan (DSNP) Optum at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member's Primary Care Provider and other providers, and other professionals. Optum providers serve people in their own homes through annual evaluations, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management.
The Social Work Clinical Manager is responsible for overseeing Social Work Case Managers and may include Registered Nurse Case Managers and participating in day-to-day clinical care of members in the Optum at Home clinical program. This position is responsible for clinical outcomes, business operation targets and overseeing the work activities of team of Registered Nurses and Social Work case managers.
• *Primary Responsibilities:**
+ Set team direction, resolve problems, and provide guidance to members of own team
+ Lead, supervise, and develop members of the DSNP clinical team
+ Oversee work activities of other supervisors and staff
+ Adapt departmental plans and priorities to address business and operational challenges
+ Influence and/or provide input to forecasting and planning activities
+ Ensures the team meets established performance metrics and performance guarantees
+ Ensure effective orientation and development for Clinical Staff
+ Utilize Complex Population Management performance tools that hold the clinical team accountable for market metrics and performance standards
+ Promote individual development by providing learning and growth opportunities to clinical staff
+ Communicate needs and issues addressed by clinical staff to local market and corporate leadership as appropriate
+ Participate in site specific strategic planning activities
+ Develop solutions to problems or barriers by partnering with key stakeholders
+ Provide clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
+ Serve as a role model to internal and external partners
+ Oversee implementation and adoption of clinical and quality initiatives
+ Use knowledge of the business and financial goals to determine and communicate clinical priorities
+ Partner with staff to achieve business goals
+ Monitor and hold clinical team accountable for Model of Care documentation
+ Actively engage, coach and drive clinical staff in implementing activities to grow new membership
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:**
+ Master's degree in social work
+ Current unrestricted LICSW license in Washington DC or ability to obtain LICSW license in Washington DC within 90 days of hire
+ 3+ years of related management experience with focus on managing and developing a clinical team, preferably in a home care and/or long-term care setting
+ Proven experience in developing and sustaining internal and external client relationships with healthcare professionals
+ Proficient computer skills including the ability to document medical information with written and electronic medical records
+ Valid Driver's License and access to reliable transportation that will enable you to travel to member homes/facilities and/or other clinical sites within a designated area
+ Willing or ability to up to 25-50% travel within Washington, D.C.
+ Live within 50 miles of Washington, D.C.
• *Preferred Qualifications:**
+ Certified Case Manager Certification (CCM)
+ Knowledge of Medicare Dual (DSNP) and Medicaid environment
+ Knowledge of Long-Term Services and Support (LTSS) and Home and Community Based Services (HCBS)
+ Knowledge with managing complex behavioral health and psycho-social needs
+ Field-based work experience within member homes
+ Proven solid business acumen including analysis and business planning experience
+ Proven solid organizational skills and multitasking abilities will be keys to success
+ Proven solid clinical critical thinking skills
+ Excellent communication skills and demonstrated ability to foster a culture of clinical excellence and build collaborative relationships
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 salary for this role will range from $89,900 to $160,600 annually 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._
_vjm_
Social Worker - Manager of Case Management - Washington D.C. - Optum at Home
UnitedHealth Group
**
Martin's Additions, MD
Posted about 21 hours ago
**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 members access and navigate care anytime and anywhere.
As a team member of our Optum at Home product, together with an interdisciplinary care team we help members navigate the health care system and connect them to key support services. This preventive care can help members stay well 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.**
The Dual Special Needs Plan (DSNP) Optum at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member's Primary Care Provider and other providers, and other professionals. Optum providers serve people in their own homes through annual evaluations, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management.
The Social Work Clinical Manager is responsible for overseeing Social Work Case Managers and may include Registered Nurse Case Managers and participating in day-to-day clinical care of members in the Optum at Home clinical program. This position is responsible for clinical outcomes, business operation targets and overseeing the work activities of team of Registered Nurses and Social Work case managers.
• *Primary Responsibilities:**
+ Set team direction, resolve problems, and provide guidance to members of own team
+ Lead, supervise, and develop members of the DSNP clinical team
+ Oversee work activities of other supervisors and staff
+ Adapt departmental plans and priorities to address business and operational challenges
+ Influence and/or provide input to forecasting and planning activities
+ Ensures the team meets established performance metrics and performance guarantees
+ Ensure effective orientation and development for Clinical Staff
+ Utilize Complex Population Management performance tools that hold the clinical team accountable for market metrics and performance standards
+ Promote individual development by providing learning and growth opportunities to clinical staff
+ Communicate needs and issues addressed by clinical staff to local market and corporate leadership as appropriate
+ Participate in site specific strategic planning activities
+ Develop solutions to problems or barriers by partnering with key stakeholders
+ Provide clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
+ Serve as a role model to internal and external partners
+ Oversee implementation and adoption of clinical and quality initiatives
+ Use knowledge of the business and financial goals to determine and communicate clinical priorities
+ Partner with staff to achieve business goals
+ Monitor and hold clinical team accountable for Model of Care documentation
+ Actively engage, coach and drive clinical staff in implementing activities to grow new membership
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:**
+ Master's degree in social work
+ Current unrestricted LICSW license in Washington DC or ability to obtain LICSW license in Washington DC within 90 days of hire
+ 3+ years of related management experience with focus on managing and developing a clinical team, preferably in a home care and/or long-term care setting
+ Proven experience in developing and sustaining internal and external client relationships with healthcare professionals
+ Proficient computer skills including the ability to document medical information with written and electronic medical records
+ Valid Driver's License and access to reliable transportation that will enable you to travel to member homes/facilities and/or other clinical sites within a designated area
+ Willing or ability to up to 25-50% travel within Washington, D.C.
+ Live within 50 miles of Washington, D.C.
• *Preferred Qualifications:**
+ Certified Case Manager Certification (CCM)
+ Knowledge of Medicare Dual (DSNP) and Medicaid environment
+ Knowledge of Long-Term Services and Support (LTSS) and Home and Community Based Services (HCBS)
+ Knowledge with managing complex behavioral health and psycho-social needs
+ Field-based work experience within member homes
+ Proven solid business acumen including analysis and business planning experience
+ Proven solid organizational skills and multitasking abilities will be keys to success
+ Proven solid clinical critical thinking skills
+ Excellent communication skills and demonstrated ability to foster a culture of clinical excellence and build collaborative relationships
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 salary for this role will range from $89,900 to $160,600 annually 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._
_vjm_
Medical Assistant - Bowie, MD
UnitedHealth Group
**
Lothian, MD
Posted 2 months ago
The Optum Serve Medical Assistant for the Dedicated network provides clinically competent delivery of quality medical care services required during Optum Serve operations within their scope of practice. The MA working at any Optum Serve site is responsible for safe patient care and ensuring adherence to all Optum Serve Policies and Procedures. All Optum Serve on-site staff and contractors must be fully vaccinated per CDC guidelines. Contracts Serviced: Multiple.
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 to start **Caring. Connecting. Growing together.**
• *Location:** 4201 Northview Drive, Suite 410 Bowie, MD 20716
• *Schedule:** Monday - Friday, 7:30 a.m. - 4:30 p.m.
• *Primary Responsibilities:**
This role is patient-facing and can require working in a clinical setting. It is customer-facing with high expectations for operational excellence. Hours may vary based on location, patient volume, and business needs. This list of essential functions is not exhaustive and may be supplemented and changed as necessary.
+ Critical Thinking and Problem-Solving: Exhibit excellent critical thinking, problem-solving, verbal and written communication skills, in addition to attention to detail
+ Customer Service, Compassion, and Teamwork: Build rapport with team members, internal and external customers, and management by demonstrating a solid customer service orientation and genuine compassion. Provide empathetic and patient-centered care, ensuring that all interactions are respectful, supportive, and focused on the well-being of patients and colleagues. Foster a collaborative team environment by actively participating in team activities, supporting colleagues, and contributing to a positive and cohesive work atmosphere
+ Professionalism: Always act professionally with minimal supervision as a representative of Optum Serve
+ Organizational Skills: Possess solid organizational skills and the ability to prioritize, solve moderately complex problems while working both independently and collaboratively with others. Organize workload, set priorities, complete assignments in a timely manner, and utilize resources appropriately while complying with organizational standards
+ Compliance: Maintain compliance with Optum Serve and Federal, State, and Local regulatory, contractual, and organizational guidelines including HIPAA as outlined in training and policies/procedures, quality assurance, and improvement processes. Abide by all Optum Serve and Contractual policies and procedures to comply with all infection control, quality assurance, and protocols
+ Punctuality: Be punctual for work attendance and abide by the work schedule. Be present and remain on site during scheduled hours
+ Language Skills: If fluent in other languages, assist patients and providers with translation as necessary and to the limit allowed by qualifications/certification
+ Reporting: Work with providers and operational teams to ensure reports are submitted timely and accurately. Assist in the preparation and delivery of reports for all lines of business
+ N95 Fit Testing: Provide proof of or be N95 Fit Tested depending on the scope of operations
+ Collaboration and Compliance: Partner with Clinical Quality Leadership and other healthcare professionals to ensure compliance with all clinical policies and training programs, maintain and enhance quality assurance processes, adhere to best practices and clinical guidelines, participate in performance improvement initiatives, engage in continuous professional development
+ Patient Care and Support: Provide support to providers and other clinical/nonclinical staff members. Direct individual patient care activities and coordinate with other staff members as required and within the appropriate scope of practice. Direct individual patient care activities and coordination including interviewing patients, measuring vital signs and records information on patient's charts, drawing and collecting blood samples from patients, preparing specimens for laboratory analysis/ complete lab requisitions, and conducting a variety of diagnostic tests
+ Administrative Duties: Responsible for routine and basic front and back-office duties, to include answering phones, scheduling, and confirming appointments, preparing schedules, data entry (including referral contracts, post appointment information), prefill, document retrieval, filing, performing data entry, and assisting in the examination process of patients under the direction of a physician or other licensed providerTechnology: Skilled in utilizing EMR and MS Office Suite software applications
+ Inventory Management: Manage supply inventory and escalate gaps as quickly as possible. Including the responsibility for daily logs, monthly, and yearly compliance logs
+ Personal Hygiene and Appearance: Maintain good personal hygiene and present a well-groomed and professional appearance in accordance with the policy and/or as directed by leadership. Clothing, including scrubs for healthcare professionals, should be clean, in good repair, and properly fitting. Clothing that is faded, stained, discolored, torn, patched, ripped, frayed, or otherwise distressed is not acceptable. Clinical professionals should ensure their attire reflects a high standard of professionalism and cleanliness
+ Service Animals: Provide care for individuals with service animals, ensuring compliance with legal requirements. Ensure that service animals are accommodated and that their presence is respected, providing necessary support and assistance to both the individual and their service animal
+ Patient Identification and HIPAA Compliance: Apply proper patient identification practices and ensure HIPAA compliance
+ Housekeeping: changing exam room table paper, disinfecting surfaces, upkeep of tidiness of the entire clinic (exam rooms, bathrooms, waiting area, front office, lab room, etc.), ensuring all equipment is clean and presentable
+ Patient Education: Provide and ensure patient education is current and accurate, if within your scope of practice
+ Emergency Response: Provide support to clinicians when needed in medical response to patients with medical needs and/or activate the Emergency Medical Services when an emergency happens
+ Other Duties: Assist with other duties of the site, including administrative work and any other duties as assigned during downtime. This list of functions is not exhaustive and may be supplemented and changed as necessary, in addition to any other functions as assigned by leadership or contract obligations
• *Role Responsibilities & Attributes**
+ Mental Demands
+ Reading, writing, attention to detail, confidentiality, problem-solving, ad hoc decision-making skills, math skills, reasoning skills, oral communication, written communication, customer contact, multiple concurrent tasks, stress management skills, interpersonal skills
+ Physical Demands
+ Bending, crouching, kneeling, squatting, lifting/carrying up to 50 lbs., handling (holding, grasping, turning, or otherwise working with the hand or hands), fingering (picking, pinching, fine manipulation), sitting, standing for long periods of time, and walking. Seeing and hearing alarms and settings during and after business hours and responding according to training and procedures. Setting and resetting devices with small knobs and handles
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:**
+ Associate degree in medical assisting and/or graduation from an accredited vocational Medical Assistant program, and/ or maintains unrestricted and in good standing certification as a Certified Medical Assistant (CMA)
+ IF required by state of operation: Maintains unrestricted and in good standing certification as a Certified Medical Assistant (CMA)
+ Phlebotomy Certification from accrediting training course, when required by state requirements
+ Active/Current Basic Life Support (BLS) Certification
+ Willingness to complete CAOCH and Drug Testing Collection Certifications
+ Ability to successfully pass National Agency Check with Inquiries (NACI) background investigation
+ 3+ years of relevant clinical experience (i.e., Primary Care, Family Care, Internal Medicine, Occupational Health, or Urgent Care)
+ Valid U.S. Driver's License and ability/willingness to drive between work locations
• *Preferred Qualifications:**
+ Current certification in Audio and Drug Testing Collection
+ Experience working with Veterans, Service Members and Federal Employees
+ Experience performing EKG, PFTs, ABIs, venipuncture, lab processing, etc.
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 $17.98 to $32.12 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._
_OptumCare 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._
_OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
Medical Assistant - Bowie, MD
UnitedHealth Group
**
Lothian, MD
Posted about 21 hours ago
The Optum Serve Medical Assistant for the Dedicated network provides clinically competent delivery of quality medical care services required during Optum Serve operations within their scope of practice. The MA working at any Optum Serve site is responsible for safe patient care and ensuring adherence to all Optum Serve Policies and Procedures. All Optum Serve on-site staff and contractors must be fully vaccinated per CDC guidelines. Contracts Serviced: Multiple.
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 to start **Caring. Connecting. Growing together.**
• *Location:** 4201 Northview Drive, Suite 410 Bowie, MD 20716
• *Schedule:** Monday - Friday, 7:30 a.m. - 4:30 p.m.
• *Primary Responsibilities:**
This role is patient-facing and can require working in a clinical setting. It is customer-facing with high expectations for operational excellence. Hours may vary based on location, patient volume, and business needs. This list of essential functions is not exhaustive and may be supplemented and changed as necessary.
+ Critical Thinking and Problem-Solving: Exhibit excellent critical thinking, problem-solving, verbal and written communication skills, in addition to attention to detail
+ Customer Service, Compassion, and Teamwork: Build rapport with team members, internal and external customers, and management by demonstrating a solid customer service orientation and genuine compassion. Provide empathetic and patient-centered care, ensuring that all interactions are respectful, supportive, and focused on the well-being of patients and colleagues. Foster a collaborative team environment by actively participating in team activities, supporting colleagues, and contributing to a positive and cohesive work atmosphere
+ Professionalism: Always act professionally with minimal supervision as a representative of Optum Serve
+ Organizational Skills: Possess solid organizational skills and the ability to prioritize, solve moderately complex problems while working both independently and collaboratively with others. Organize workload, set priorities, complete assignments in a timely manner, and utilize resources appropriately while complying with organizational standards
+ Compliance: Maintain compliance with Optum Serve and Federal, State, and Local regulatory, contractual, and organizational guidelines including HIPAA as outlined in training and policies/procedures, quality assurance, and improvement processes. Abide by all Optum Serve and Contractual policies and procedures to comply with all infection control, quality assurance, and protocols
+ Punctuality: Be punctual for work attendance and abide by the work schedule. Be present and remain on site during scheduled hours
+ Language Skills: If fluent in other languages, assist patients and providers with translation as necessary and to the limit allowed by qualifications/certification
+ Reporting: Work with providers and operational teams to ensure reports are submitted timely and accurately. Assist in the preparation and delivery of reports for all lines of business
+ N95 Fit Testing: Provide proof of or be N95 Fit Tested depending on the scope of operations
+ Collaboration and Compliance: Partner with Clinical Quality Leadership and other healthcare professionals to ensure compliance with all clinical policies and training programs, maintain and enhance quality assurance processes, adhere to best practices and clinical guidelines, participate in performance improvement initiatives, engage in continuous professional development
+ Patient Care and Support: Provide support to providers and other clinical/nonclinical staff members. Direct individual patient care activities and coordinate with other staff members as required and within the appropriate scope of practice. Direct individual patient care activities and coordination including interviewing patients, measuring vital signs and records information on patient's charts, drawing and collecting blood samples from patients, preparing specimens for laboratory analysis/ complete lab requisitions, and conducting a variety of diagnostic tests
+ Administrative Duties: Responsible for routine and basic front and back-office duties, to include answering phones, scheduling, and confirming appointments, preparing schedules, data entry (including referral contracts, post appointment information), prefill, document retrieval, filing, performing data entry, and assisting in the examination process of patients under the direction of a physician or other licensed providerTechnology: Skilled in utilizing EMR and MS Office Suite software applications
+ Inventory Management: Manage supply inventory and escalate gaps as quickly as possible. Including the responsibility for daily logs, monthly, and yearly compliance logs
+ Personal Hygiene and Appearance: Maintain good personal hygiene and present a well-groomed and professional appearance in accordance with the policy and/or as directed by leadership. Clothing, including scrubs for healthcare professionals, should be clean, in good repair, and properly fitting. Clothing that is faded, stained, discolored, torn, patched, ripped, frayed, or otherwise distressed is not acceptable. Clinical professionals should ensure their attire reflects a high standard of professionalism and cleanliness
+ Service Animals: Provide care for individuals with service animals, ensuring compliance with legal requirements. Ensure that service animals are accommodated and that their presence is respected, providing necessary support and assistance to both the individual and their service animal
+ Patient Identification and HIPAA Compliance: Apply proper patient identification practices and ensure HIPAA compliance
+ Housekeeping: changing exam room table paper, disinfecting surfaces, upkeep of tidiness of the entire clinic (exam rooms, bathrooms, waiting area, front office, lab room, etc.), ensuring all equipment is clean and presentable
+ Patient Education: Provide and ensure patient education is current and accurate, if within your scope of practice
+ Emergency Response: Provide support to clinicians when needed in medical response to patients with medical needs and/or activate the Emergency Medical Services when an emergency happens
+ Other Duties: Assist with other duties of the site, including administrative work and any other duties as assigned during downtime. This list of functions is not exhaustive and may be supplemented and changed as necessary, in addition to any other functions as assigned by leadership or contract obligations
• *Role Responsibilities & Attributes**
+ Mental Demands
+ Reading, writing, attention to detail, confidentiality, problem-solving, ad hoc decision-making skills, math skills, reasoning skills, oral communication, written communication, customer contact, multiple concurrent tasks, stress management skills, interpersonal skills
+ Physical Demands
+ Bending, crouching, kneeling, squatting, lifting/carrying up to 50 lbs., handling (holding, grasping, turning, or otherwise working with the hand or hands), fingering (picking, pinching, fine manipulation), sitting, standing for long periods of time, and walking. Seeing and hearing alarms and settings during and after business hours and responding according to training and procedures. Setting and resetting devices with small knobs and handles
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:**
+ Associate degree in medical assisting and/or graduation from an accredited vocational Medical Assistant program, and/ or maintains unrestricted and in good standing certification as a Certified Medical Assistant (CMA)
+ IF required by state of operation: Maintains unrestricted and in good standing certification as a Certified Medical Assistant (CMA)
+ Phlebotomy Certification from accrediting training course, when required by state requirements
+ Active/Current Basic Life Support (BLS) Certification
+ Willingness to complete CAOCH and Drug Testing Collection Certifications
+ Ability to successfully pass National Agency Check with Inquiries (NACI) background investigation
+ 3+ years of relevant clinical experience (i.e., Primary Care, Family Care, Internal Medicine, Occupational Health, or Urgent Care)
+ Valid U.S. Driver's License and ability/willingness to drive between work locations
• *Preferred Qualifications:**
+ Current certification in Audio and Drug Testing Collection
+ Experience working with Veterans, Service Members and Federal Employees
+ Experience performing EKG, PFTs, ABIs, venipuncture, lab processing, etc.
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 $17.98 to $32.12 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._
_OptumCare 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._
_OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
Medicaid Reporting Manager - Remote
UnitedHealth Group
**
Chicago, IL
Posted 21 days ago
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
Optum State Government partners with state and local agencies to help modernize and manage Medicaid, health and human services, and public health programs through data-driven technology, analytics, and operational support-improving access to care, program efficiency, and outcomes for the populations they serve.
The Medicaid Reporting Manager is a leadership role responsible for managing state and federal Medicaid reporting projects, acting as a liaison between the business team on the state side and the technical team on the Optum side, and requiring strong business acumen, Medicaid program knowledge, and experience with data warehousing and reporting projects. The manager will drive the reporting solution requirements and provide Medicaid directions to the team and be and be the SME.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
**Primary Responsibilities:**
+ Lead state and federal Medicaid reporting initiatives, serving as the primary liaison between state business stakeholders and Optum technical teams, leveraging strong Medicaid program knowledge, business acumen, and data warehousing/reporting expertise
+ Direct the Illinois Enterprise Data Warehouse analytics and master data management programs, overseeing platforms and deliverables including OPA, AEP, Symmetry, Federal Reporting (PERM, T MSIS, MARS, QoC), Medicaid operational reporting, ad hoc analytics, and HHS interoperability
+ Act as an analytics leader within the OGS Analytics practice, shaping reusable solutions and guiding product direction across analytics assets (OPA, AEP, Symmetry, Federal Reporting, PI)
+ Provide strategic and tactical direction to M&O and DDI teams on business requirements, solution design, and quality assurance for reporting deliverables
+ Lead and coordinate cross functional project teams (PMs, SMEs, analysts, developers, architects, testers, and administrators) to deliver contractual and project commitments while managing scope, timeline, risk, and dependencies
+ Serve as a trusted advisor and thought leader to state customer leadership, CMS, sister agencies, and vendors; manage customer relationships and proactively identify needs and solutions
+ Present insights, recommendations, and guidance to Optum and customer executive leadership on complex Medicaid data, reporting, and compliance topics
+ Stay current on Medicaid industry trends, Illinois legislative requirements, and federal CMS mandates to inform strategy and guide customer teams
+ Support growth of the analytics practice through innovation, knowledge sharing, and contribution to program and organizational objectives
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:**
+ 10+ years of IT experience including 5+ years of leadership experience in data warehouse/data analytics/reporting projects, especially with project scope, resources, solution, risk/issues, communication, and stakeholders' management
+ 5+ years of business experience working/leading Medicaid projects with healthcare analytics and reporting in a multi-vendor environment
+ 5+ years of technology background with knowledge/experience in large DBMS, data, ETL, BI tools
+ 3+ years of proven experience leading complex and demanding Design, Development and Implementation projects with Business Intelligence/Data Analytics for decision support systems
+ Experience with Medicaid Program including Program management, Program Integrity, and Federal Reporting (such as PERM, T-MSIS, MARS, and Quality of Care core measures
**Preferred Qualifications:**
+ PMI Project Management Professional certified or Certified Business Intelligence Professional (CBIP) certification
+ 5+ years of experience with commercial or public healthcare insurance
+ 3+ years of proven client-facing skills, excellent written, verbal communication skills, and presentation skills to executive teams
+ Experience with infrastructure management
+ Experience or knowledge of Tableau, PowerBI, Teradata/IntelliFlex, Informatica MDM, Verato, SAP Business Objects, JIRA, MS Project, or SAS
+ State Medicaid Data Warehouse or Medicaid Management Information Systems experience
+ Experience with Agile methodology, Scrum framework, and Agile/Scrum projects
+ Experience with Cloud based technology such as MS Azure, Snowflake database, Python, Azure Data Factory, Data Bricks, et al
+ Experience with managing complex application development projects with 10 or more resources, especially with Cloud based implementations
+ Experience managing customer relationships and stakeholder management
+ Reside local to Springfield, IL area or in driving distance to come to State office based on customer need (around 20% travel to Springfield, IL)
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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 salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
**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._
Director of Regulatory Adherence - Remote
UnitedHealth Group
**
Schaumburg, IL
Posted about 2 months ago
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Serves as Legal interface with Operations for resolution of regulatory issues with BOPs, DEA and other agencies that inspect and regulate our Genoa pharmacies in every state. Meets with pharmacy operators & regulators, conducts investigations, drafts and reviews responses in collaboration with operators, advises attorneys on operational effectiveness and feasibility of proposed responses, participates in the preparation and review of policies and procedures and assists leadership in developing compliant operational solutions. Also conducts controlled substance monitoring and assists in the preparation and submission of DEA 106 loss reports. Serves as a single point of contact for the ingestion of regulatory and operational complaints or issues from Genoa that require legal review or intervention. May attend BOP meetings. Participates in audits and interfaces with Compliance in connection with Compliance activities. Reviews pharmacy licenses and supports accreditation activities. Uses regulatory knowledge and knowledge of operational processes to triage regulatory issues for Legal and on behalf of pharmacy. Performs other, related functions as required.
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:**
+ Licensed Pharmacist, with 7+ years of experience
+ Operations experience in a dispensing role
+ Leadership experience (PIC, District Manager or similar)
+ Experience with regulators (BOP, DEA, etc.)
+ Excellent writing and analytic skills
**Preferred Qualifications:**
+ Attorney, paralegal, compliance or other related
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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 salary for this role will range from $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
**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._