Clinical Manager RN, STAR+PLUS - El Paso, TX - Remote 2372532 | El Paso, Texas | Remote

Service Coordination Manager, RN

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.

The Service Coordination Manager, RN provides oversight and direction to the service coordination staff, as well as identify process improvements. The Service Coordinator Manager will lead the way in developing, implementing policies and procedures as necessary to ensure timeliness and accurate delivery of non-waiver and waiver services to achieve optimal outcomes for Star+Plus members.

If you live within a commutable distance of El Paso, TX, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Provide supervision and oversight of service coordination staff
• Participate in interdepartmental meetings to represent service coordination needs, including but not limited to: utilization management, provider relations, operations, finance, quality improvement and member services
• Facilitate orientation and training of service coordination staff and provides appropriate feedback and evaluation of progress
• Establish goals for performance standards of service coordinator
• Provide ongoing training and development of service coordination staff to achieve performance standards
• Identify problems / barriers / opportunities for intervention. Provides resolution and revision of plans on an ongoing basis
• Provide analysis and reporting to ensure compliance with HHSC, TDI, UMCC and URAC standards
• Manage field staff productivity goals, member satisfaction and outcomes measures
• Conduct ride-along and telephonic auditing to support a part of staff evaluation and monitoring
• Develop and maintain corrective action plans as identified

Knowledge and Skills:

• Able to apply highly technical principles, concepts, and techniques central to the nursing profession in the case management process; specifically with complex populations and waiver
• Must have excellent written and verbal communication skills, impeccable negotiating skills, ability to interact with a wide variety of individuals, and handle several complex situations simultaneously
• Must have evidence of leadership, creativity, integrity and initiative, and sound problem-solving skills
• Must provide attention to detail and follow up
• Analytical decision making and judgment skills
• Demonstrated ability to function as a clinical care team leader

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 school of nursing
• Current unrestricted RN license in Texas
• 7+ years of experience in healthcare with 2+ years of experience in managed care
• 3+ years of management or supervisory experience in managed care
• Hands-on experience with STAR+PLUS and LTSS program operations and service delivery
• Experience with electronic charting and review
• Proficiency in a Windows based environment including Microsoft applications such as Word, Excel, and Outlook
• Fluent in both English and Spanish language (written and verbal)
• Ability to travel locally up to 40% of the time
• Driver's license and access to reliable transportation with a valid driver's license and a good driving record

Preferred Qualifications:

• Bachelor's Degree
• CCM and Rug Certification
• 10+ years of managed health care experience
• 4+ years of experience working with Medicaid Waiver populations
• Experience in managing, evaluating, and composing operational reports
• Field-based work experience
• Star+Plus management/supervisory experience (operational and process improvement)

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). The salary for this role will range from $91,700 - $163,700 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 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.