Manager of Health Services - Hybrid - Phoenix, Arizona

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The Manager of Health Services reports directly to the Director of Heath Services. This position is responsible for the management and oversight of multiple Clinical Operational departments responsible for regulatory programs and coordinates the care and services delivered to selected patient populations promoting effective utilization of resources.

The Manager of Health Services has oversight of Internal Business Partners who perform clinical functions which meet regulatory and contract requirements. These responsibilities include, but are not limited to, LTC Transition Coordination, Intake and Prior Authorization, Transition of Care Program (ETI), Justice Reach-In Program, Performance/monitoring of Health Risk Assessments (HRA) provided by the HARC team, ED Diversion programs, monitoring of performance reports, and collaboration with integrated Behavioral Health Programs.

The Manager will have direct reports and provide oversight which tracks adequate service delivery which includes identification of barriers and any gaps in care, and processes in place to monitor member's medical, behavioral health and pharmacy services.

This role has responsibility for program planning and development, implementing, managing and coordinating services according to state contract requirements. Responsible for reviewing the state AMPM/AdSS/CFRs and Health Plan Contracts to ensure all requirements are being met in the program. The primary focus is to monitor clinical activities, ensure compliance is met, and advise leadership on improvement opportunities which impact medical expense. This role will Interface with Quality Management regarding HEDIS measures when applicable.

The Manager will attend the monthly HQUM (Medical Management meetings) and present program performance metrics on a regular basis; lead other internal and external regulatory meetings as necessary.

If you are located in Phoenix, AZ, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges. Hybrid position working in the Phoenix, AZ office 1-2 days per week.

Primary Responsibilities:

• Performs oversight of UnitedHealthcare Community Plan (UHCCP) Clinical programs: Justice Reach In, ETI Transition Program, HRA, and ED Diversion and others as needed
• Ensure seamless and smooth transition of LTC members transitioning into and out of the Health Plan
• Monitor quality of care issues according to Plan UM/QA policy and procedures
• Provide feedback to Director of Health Services of program oversight performance
• Interface with the Clinical Management team as needed
• Works closely with Business Partners to ensure regulatory compliance is met
• Provides monthly statistics and reports on clinical programs with whom there is direct oversight
• Assist the Director of Health Services to monitor the effectiveness of Clinical Programs
• Assists with program improvement projects
• Serves as liaison to other health services departments (Care Management, Maternal Health Program, Behavioral health, QM, Pharmacy)
• Possess a global understanding of the Health Services department and coordinates services
• Performs other duties for the department as requested by Health Plan Leadership
• Develops, revises, and submits policies and procedures which meet regulatory requirements and enhance operational processing
• Prepare regulatory reports as required
• Complete special projects as assigned
• Demonstrate ability to focus health plan clinical activities toward a strategic direction as well as develop tactical plan, drive performance and achieve targets
• Problem solve skills: the ability to systematically analyze program performance, draw relevant conclusions and implement appropriate courses of action
• Excellent verbal and written communication skills; ability to speak clearly and concisely, convey complex or technical information in a manner that others can understand
• Contributes to developing new programs specific to the state requirements
• Sets team direction, resolves problems and provides guidance to members of their own team
• Adapts departmental plans and priorities to address business and operational challenges
• Overall responsibility for workflow activities & activities for designated teams
• Provides clinical expertise to the clinical team and support staff
• Provides mentorship and training for team members
• Represents the department in assigned Plan committees/meetings
• Assists with all team member Human Resource activities
• Supports excellent employee performance and encourage staff development
• Adhere to ethical, legal/regulatory and accreditation standards to meet business goals and objectives
• Adapt departmental plans and priorities to address business and operational challenges
• Analyze utilization reports and develop departmental specific action plans
• Communicate with providers and members as needed
• Develops and submits Provider and Member educational materials
• Ensures clinical teams meet established performance metrics and performance guarantees
• Adapts departmental plans and priorities to address business and operational challenges
• Strategy development with execution
• Establishes product, service or process decisions that will impact multiple groups of employees and/or customers (internal or external)
• Proven history of driving operational performance and achieving established metrics
• Excellent communication skills with the ability to interrelate with individuals at various levels
• Ability to develop effective business relationships across business and product teams
• Ensures all reporting needs both internal and external are available for performance reviews and monthly/annual reporting
• Assist in completing the Annual UMMM Work Plan, UM Evaluation document and MM/UM Program Description document for submission to the regulators
• Assist in completing the NCQA documentation for submission

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 Arizona Registered Nurse license
• 5+ years of professional level clinical experience
• 5+ years of team lead, supervisory, and/or management experience
• Advanced computer proficiency (MS Word, Outlook, Internet,Visio)
• Proven analytical skills
• Ability to travel up to 10% of time within the state of Arizona/Phoenix metropolitan area
• Ability to work 1-2 days per week in the office
• Ability to be onsite for Regulatory Audits, HQUM, and Town Halls

*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.