For those who want to help shape the future of maternal health, this role offers the opportunity to support a maternity care management program that connects pregnant and postpartum Medicaid members to timely, coordinated, person-centered care.
The MCH Manager is responsible for the operational, clinical, and strategic oversight of the maternity case management program. This role leads pediatric and maternity case managers, Community Health Workers, and other support staff responsible for member outreach, risk stratification, assessment, care planning, care coordination, education, and connection to appropriate resources.
This position partners with market leadership, providers, community organizations, and national clinical teams to support regulatory compliance, improve member engagement, strengthen documentation practices, and advance maternal and infant health outcomes. The Manager also supports implementation of initiatives, pilots, modernization efforts, and quality improvement activities.
If you are located in NC, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Program Oversight Responsibilities
- Lead, supervise, coach, and support pediatric and maternity case managers, Community Health Workers, and other program staff
- Oversee member identification, outreach, assessment, risk stratification, individualized care plan development, monitoring, and postpartum follow-up activities
- Ensure compliance with national, state, federal, contractual, accreditation, and organizational requirements
- Ensure accurate, timely, and complete documentation in CommunityCare and other applicable clinical systems
- Monitor caseload distribution, workload, staffing needs, productivity, member engagement, quality outcomes, operational metrics, and program audits
- Review program performance reports and identify opportunities to improve engagement, quality outcomes, affordability, workflow efficiency, and member experience
- Support market implementation of pediatric and maternity initiatives, program enhancements, pilots, modernization efforts, and strategic maternal child health priorities
- Lead or support quality improvement projects focused on maternal and pediatric outcomes, prenatal and postpartum engagement, NICU-related trends, and care coordination performance
- Partner with market leaders, providers, Provider Services, Network, Quality, Behavioral Health, Community & State partners, and national clinical operations teams to strengthen program performance
- Support audit readiness, corrective action planning, regulatory reporting, and internal program reviews
- Clinical Leadership Responsibilities
- Provide clinical guidance and consultation for complex maternity and pediatric cases, including high-risk pregnancy, high-risk pediatrics, behavioral health needs, social/environmental needs, and complex care coordination concerns
- Promote completion of assessments, individualized care plans, ongoing monitoring, reassessments, and follow-up consistent with program requirements
- Ensure members are supported through coordination with obstetrical providers, pediatric providers, primary care providers, behavioral health providers, specialists, community programs, and other interdisciplinary care team members
- Provide coaching, training, technical assistance, and clinical feedback to care management staff.
Monitor clinical adherence and documentation quality through chart reviews, audit findings, and performance discussions - Reinforce evidence-based care management practices that promote pediatric and prenatal care engagement, postpartum care, family planning, breastfeeding education, safe sleep education, and connection to community resources as applicable
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:- Active, unrestricted RN license
- 5+ years of maternal-child health, obstetrical nursing, pediatric nursing, neonatal, case management, population health, or closely related clinical experience
- Experience working in Medicaid managed care or a comparable health plan environment
- Experience supporting clinical program operations, quality improvement activities, regulatory compliance, and performance monitoring
- Knowledge of maternity/pediatric care management models, NCQA standards, state Medicaid requirements, clinical documentation expectations, and care coordination workflows
- Intermediate MS Office skills, including Word, Excel, Teams, Outlook, and PowerPoint
- Demonstrated ability to lead teams, manage competing priorities, communicate effectively, and drive operational results
- Reliable transportation and the ability to travel within assigned territory to meet with employees, members, and providers
- Proven ability to remain stationary for long periods of time to complete computer or tablet work duties
Preferred Qualifications:- BSN, MSN, MPH, or other advanced degree in nursing, public health, healthcare administration, or related field
- Maternal Child Health, case management, care coordination, quality improvement, or population health certification
- 2+ years of leadership, supervisory, clinical oversight, or program management experience
- Experience with high-risk maternity and high-risk pediatric case management programs
- Experience leading program transformation, clinical redesign, digital engagement, automation, or modernization initiatives
- Experience analyzing operational metrics, quality outcomes, member engagement data, and regulatory performance indicators
- Proven solid presentation, project management, stakeholder engagement, and cross-functional leadership skills
*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 $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
