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Health Services Manager

4 months ago

Lexington, United States UnitedHealth Group Full time

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Maternal Child Health Manager (MCH-PM) has strategic oversight, cross-functional management and responsibility for the delivery of quality and affordability results for the Kentucky Health Plan’s Maternal Child Health Programs. The MCH-PM must have a current and unrestricted KY RN License. Results are critical to this Program Manager’s success, as is a personal alignment with UnitedHealthcare mission to help Kentuckians live healthier lives and the core belief that an organization can manage cost and deliver quality and value to its customers. This position is responsible for ensuring the efficacy of the Maternal Child Health Programs through various internal and external collaborative relationships, continuous quality improvement strategies, and strategic initiatives. The Maternal Child Health Manager works closely with the Health Plan clinical leaders including the Chief Medical Officer, Health Services Director, and Quality Director to achieve the goals and objectives of the KY Maternal Child Health Programs. It is ultimately the responsibility of the Maternal Child Health Manager to oversee the primary clinical objectives by partnering closely with the Health Plan Leaders to ensure compliance with the state of KY vision for maternal and child health program initiatives. If you are located in Louisville or Lexington, Kentucky, or within a commutable driving distance, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Use industry knowledge of the maternity medical, behavioral and community-based partners landscape, to inform and execute on business objectives by developing the clinical operations strategy in partnership with the Community Stakeholder Leaders behind the maternal child health program Promote preventive care and family planning services through various communication mediums and community-based events Lead and manage the day-to-day operations of the Maternal Child Health Programs for KY, which includes the High Risk OB, NICU, PDN programs. Oversight of staff, day-to-day activities, auditing of cases and phone calls, coaching for performance metrics to achieve program goals. Monitor and oversee execution of performance and activities to improve health and quality outcomes and effective medical management (e.g., HEDIS, infant mortality, pre-term births, and NICU admissions, Private Duty Nursing) Monitoring, measuring and managing Health Plan performance against state compliance, quality and affordability goals for the Maternal Child Health Programs, NICU and Private Duty Nursing Programs Ensuring all components of the program, delivered by the Call Center Advocates, Community Health Workers, Registered Nurses, Doulas and external providers and community-based organizations tie together into a comprehensive and seamless member experience As applicable, manage highly complex maternity or pediatric members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc. 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 KY/Compact RN License 4+ years of Maternal and/or Pediatric/NICU clinical experience 2+ years of experience working with Medicaid members and/or experience working with underserved communities. 2+ years of supervisor/management experience (e.g., Review work of others, Serve as an expert in their field, Serve as a mentor and leader, Lead functional or segment teams or projects) 1+ years of clinical program development and/or program oversight experience Proficiency with Microsoft Office Suite Lives in Louisville or Lexington, if not in Louisville must be able to travel to Louisville weekly for meetings and meet with team members throughout the state as needed Ability to travel within the state of KY approximately 25% of the time (statewide) Preferred Qualifications: Advanced degree (MSN, MPH) 1+ years of community and/or public health experience 1+ years project management, change management experience, demonstrated history of managing programs or projects 1+ year of managed care, utilization management, clinical care coordination and/or case management experience Excellent communication, writing and presentation skills *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 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. 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.