1+ months

Director of Medical Management (RN) - Ontario, CA - 893488

Ontario, CA 91764
  • Job Code
    893488

North American Medical Management,"California, Inc (NAMM California)"partnered with OptumHealth in 2012. NAMM California and OptumHealth share a"common goal of bringing patients, physicians, hospitals and payers closer"together in the mission to increase the quality, efficiency and affordability"of care. NAMM California is a part of the family of companies that make"UnitedHealth Group one of the leaders across most major segments of the US"health care system. NAMM California develops and managers provider networks,"offering a full range of services to assist physicians and other providers in"supporting patient care coordination and their managed care business"operations. For over 18 years, NAMM California has been an innovator in health care"with a track record for quality, financial stability, extraordinary services"and integrated medical management programs. NAMM California is well positioned"to continually invest in its infrastructure and systems for the benefit of its"provider clients and to accommodate the impending changes that will come forth"from healthcare reform.

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The NAMM California provider clients"represent a network of almost 600 primary care physicians and over 3,000"specialists and work with the premier hospitals in their respective markets.

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As a part of our continued growth,"we are searching for a Director of"Medical Management (RN) to join our team In this role, you will be"responsible for providing leadership and administrative oversight, program"development, implementation, and evaluation of Case Management & UM"Programs, chronic care programs, and support of PrimeCare Medical Network, Inc."and IPA Medical Management functions.

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Travel required within the following"markets:"*San Diego, San Bernardino, Riverside, Palm Springs, Ontario (regional office). The business will adhere"to following all COVID-19 social distancing policies and will provide appropriate"PPE.

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Primary Responsibilities:
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  • Oversees one or more IPA's formal utilization and" network coordination services. Provides operational oversight and" recommends corrective action for all shared services
  • Manages the UM results of one or more of the IPA's," including referral management; acute, SNF and Rehab admissions for the" IPA.
  • Continually creates and implements strategies to" improve IPA and UM Departments performance
  • Participates in PrimeCare Medical network, Inc., IPA" Utilization Management meetings to enhance communication and continuity of" member care services
  • Has management responsibility as assigned for the key" Medical Management Programs, Coordinated Care Center, DME and" Injectable Units
  • Participates in determination of department's goals and" objectives, setting organizational structure, staffing, and space planning
  • Participates in recruitment, retention, and training of" NAMM Case Management staff.
  • Acts as a resource to other departments in regards to" Case Management, Disease Management, and Chronic Care Management.
  • Collaborates with appropriate VP of Medical Management," Medical Directors, UM Managers, and other IPA staff as well as" other division peers
  • Program Development, Implementation and Evaluation
  • Conduct needs assessment including: development" of methods for determining potential patient enrollment, medical" literature review, analysis of pre-program utilization and return on" investment
  • Development of Program to include establishment" of policies and procedures, enrollment strategies, member and physician" materials, and measurements of program outcome
  • Development of clinical practice guidelines
  • Evaluate staff educational needs and coordinate training
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Primary Responsibilities:
  • Oversees one or more IPA's formal utilization and network coordination services. Provides operational oversight and recommends corrective action for all shared services
  • Manages the UM results of one or more of the IPA's, including referral management; acute, SNF and Rehab admissions for the IPA.
  • Continually creates and implements strategies to improve IPA and UM Departments performance
  • Participates in PrimeCare Medical network, Inc., IPA Utilization Management meetings to enhance communication and continuity of member care services
  • Has management responsibility as assigned for the key Medical Management Programs, Coordinated Care Center, DME and Injectable Units
  • Participates in determination of department's goals and objectives, setting organizational structure, staffing, and space planning
  • Participates in recruitment, retention, and training of NAMM Case Management staff.
  • Acts as a resource to other departments in regards to Case Management, Disease Management, and Chronic Care Management.
  • Collaborates with appropriate VP of Medical Management, Medical Directors, UM Managers, and other IPA staff as well as other division peers
  • Program Development, Implementation and Evaluation
  • Conduct needs assessment including: development of methods for determining potential patient enrollment, medical literature review, analysis of pre-program utilization and return on investment
  • Development of Program to include establishment of policies and procedures, enrollment strategies, member and physician materials, and measurements of program outcome
  • Development of clinical practice guidelines
  • Evaluate staff educational needs and coordinate training
Required Qualifications:
  • Current, active and unrestricted RN license for the state of California
  • High School Diploma or GED required
  • 5 or more years of experience with IPA's, Health Plans and Managed Care networks
  • 5 or more years of experience as a Case Manager within a managed care environment
  • 5 or more years of Management experience within the healthcare industry
  • 5 or more years of experience with community based programs (Medicaid, for example)
  • Thorough knowledge of regulations and requirements related to utilization management (UM)
  • Experience with QA/QI and program development/process improvement
  • Ability to travel locally within an 80+ mile radius.
  • Employees arerequiredto screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
Preferred Qualifications:
  • Bachelors (BSN) or Master's degree (MSN)

For more information on our Internal Job Posting Policy,click here.

Careers with Optum.Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to doyour life's best work.SM

Diversity creates a healthier atmosphere: 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: RN, nurse, Utilization Management, Case Manager, UM, UR, managed care, Hospital, Ontario, Manager, Director, Care Manager, NAMM, Care Management, NCQA, SNP, Ontario, CA, California

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Posted: 2020-10-30 Expires: 2020-12-25

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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Director of Medical Management (RN) - Ontario, CA - 893488

UnitedHealth Group
Ontario, CA 91764

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