Health Services Director - Honolulu, Hawaii at Honolulu

Description:

The Health Services Director is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). Function provides leadership to and is accountable for the performance of managers and/or senior level professional staff.

Responsibilities:

Executes the delivery of all Clinical Programs Case Management/Service Coordination and Disease Management within areas of responsibility for the Health Plans

Develops and implements clinical program structure and resource plans that are consistent with National Clinical Model based on populations serviced by Plan and revenue models

Ensures local service coordination processes, policies and procedures meet regulatory/NCQA/CMS standards and are consistent with the national clinical model

Leads, Coaches, develops, clinical leadership staff, fosters innovation to improve member outcomes

Identifies and drives local Healthcare Affordability Initiatives along with medical director(s) and clinical team

Ensures monitoring and oversight of clinical programs/staff to meet defined goals/targets, contract requirements

Works collaboratively with providers, sister-segments, service contractors and health plan management to oversee the management of a health services department with the objectives of improving the quality of care delivered to members in a range of products, i.e., Medicaid, CHIP, SSI/ABD, long term care, and dually eligible categories, improving cost efficiencies, and developing an environment of operational excellence.

Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations

Collaborates with internal and external entities to improve accessibility standards and quality practice standards to reduce medical costs across the service delivery systems (inpatient, emergency departments, urgent care services and practitioner office settings).

Utilizes timely and meaningful financial and utilization reports to assist providers in efforts to alter their care delivery patterns and improve member outcomes

Develops, translates and executes strategies or functional/operational objectives for Health Plan including medical management, financial accountability, customer and Provider satisfaction, quality improvements

Develops and implements staff retention and engagement program

Serves as the Health Plan Health Services SME and liaison with the State

Ensures clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and clinical model standards

Qualifications:

Current and unrestricted Hawaii RN licensure with a Bachelors degree in Nursing (or equivalent experience)
Extensive experience with Medicaid/Medicare populations, including LTC and TANF/CHIP
Extensive experience in development and execution of clinical programs in managed care environment
Moderate experience in field-based case management, including program implementation and monitoring
Moderate experience in Utilization Management (acute and/or HCBS)
Demonstrated track record of clinical program compliance, functional collaboration, and meeting program goals
Extensive experience as a leader with responsibility for leadership development
Proficient in the use of software applications including, but not limited to MS Office Suite (Outlook, PowerPoint, Excel, Word, Project)
Reliable vehicle, current and unrestricted drivers license, and proof of auto insurance
Ability to travel as necessary
Residency on the outer island with a predominance of outer island staff and member population

Preferred:

Masters in Nursing, Business, Healthcare Administration
NCQA/URAC Accreditation experience
Certified Case Manager
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If youre ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach. This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Country: USA, State: Hawaii, City: Honolulu, Company: UnitedHealth Group.