UnitedHealth Group

Senior Manager Medical Expense Management

UnitedHealth Group • $91K — $163K *
Worcester, MA 01604In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • BSN required
  • Current Massachusetts RN licensure
  • 5+ years of relevant experience
  • Proven experience in coordination and management of treatment services
  • Demonstrated leadership ability in building effective teams
  • Knowledge of budget development and collaborative multi-specialty program management
  • Familiarity with Utilization Management and Case Management

Responsibilities

  • Oversees utilization and referral programs, ensuring targeted outcomes are met
  • Integrates utilization and referral management for maximum effectiveness
  • Proactively identifies high-cost cases for management
  • Ensures compliance with NCQA requirements and certification processes
  • Manages departmental expenditures for various care services
  • Implements programs for proactive outreach to high-risk patients
  • Directs operational training, audits, and performance evaluations

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase options
  • 401k contribution
  • Development opportunities for career progression
Full Job Description
Responsible for coordinating care management activities and clinical program development. Provides coordination of the overall activities of care management department. Leads the development of care management objectives, policies, plans, programs and budgets while maintaining a cost efficient and effective service, supporting the organization's clinical practices.

Primary Responsibilities:

  • Oversees Utilization and Referral programs, including acute care, skilled nursing facility and home care, achieving targeted outcomes
  • Integrates utilization and referral management groups. Organizes to maximize program efficiency and effectiveness. Recruits and oversees team leaders. Oversees evaluation of the clinical performance of the department and staff. Oversees the day-to-day operations of all utilization and referral management programs
  • Manages identification of pending high cost cases
  • Responsible for compliance to and meeting all NCQA requirements for delegated case management as well as being responsible for NCQA certification for utilization management
  • Responsible for the successful implementation of all future, delegation efforts
  • Manages expenditures such as utilization: inpatient, SNF, hospital outpatient expenses: ER, facility, home care, ambulance, DME, tertiary referrals and POM with Service Director, regional leadership and others, participate in clinical program development, implementation, business plans, trade-off proposals
  • Manages inpatient and outpatient populations to anticipate needs, optimize outcomes and cost-effective care. Implements and monitors programs focused on proactive outreach for high-risk patients
  • Ensures quality of department services via ongoing training of staff, case review, internal audits and inter-rater reliability audits
  • Interfaces and resolves issues with vendors such home health care, hospitals, nursing facilities, etc., to ensure appropriate quality of care and service is delivered to patients. Participates in research activities to establish benchmarks; stay informed about innovative programs that can be replicated at the organization
  • Recruits and selects members of the utilization and referral management teams to manage the needs of assigned areas of responsibility
  • Delegates authority and responsibility to members of the teams for the operation and coordination of the programs and services
  • Works with department leaders to minimize outside referrals and resolve identified barriers to care
  • Acts as a resource for team members as needed
  • Manages the business and fiscal affairs of the department, including the preparation of business plans and annual capital and operating funds budgets. Monitor and assume corrective action for variances
  • Establishes positive working relationships with the organization's site staff as well as payer staffs and management
  • Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hire, transfers, promotions, salary changes, discipline, terminations, and other similar actions. Resolves grievances and other personnel problems within position responsibilities
  • Develops and recommends, in conjunction with manager, the operating and capital budgets for the areas managed. Manages activities to assure financial goals met. Monitors expenditures for compliance to approved budget. Resolves discrepancies
  • Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved
  • Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation, and fosters the effective integration of efforts with clinic-wide initiatives
  • Participates in performance improvement initiatives and recommends procedural changes when appropriate
  • Ensures compliance with regulatory agencies such as DPH, etc. Develops and maintains procedures necessary to meet regulatory requirement
  • Ensures that assigned area comply with clinic established policies, quality assurance programs, safety, and infection control policies and procedures
  • Ensures adequate equipment and supplies for assigned area
  • Ensures compliance to all health and safety regulations and requirements
  • Performs similar or related duties as required or directed
  • Regular, reliable and predicable attendance is required


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:

  • BSN
  • Current Massachusetts RN licensure
  • 5+ years of relevant experience
  • Proven experience in coordination and management of treatment services
  • Demonstrated leadership ability in building teams which have worked to achieve a common goal
  • Knowledge of budget development and management, and collaborative multi-specialty program development and management
  • Knowledge of Utilization Management and Case Management
  • Excellent organizational, communication, and interpersonal skills
  • Knowledge of a variety software products such Microsoft Outlook, Word, Excel, PowerPoint, etc.
  • Driver's license and access to reliable transportation


Physical Requirements:

  • Physical health sufficient to meet the ergonomic standards and demands of the position


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.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Healthcare
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ
UNH
* Ladders Estimates

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