Director Of Care Management - Americhoice - Knoxville
UnitedHealth Group (Knoxville, Tennessee)

Salary:: View salary range

Ref Code:: 71708018

Minimum Career Level:: Manager (Manager/Supervisor of Staff)

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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health. AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its membership, which includes Medicaid, Medicare and SCHIP recipients. With over a decade of growth and success, we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in the lives of our 1.7 million members. Join us, do rewarding work, and build a great career. Immediate Superior: VP, Health Services General Purpose: The Director of Care Management is responsible for administering and managing the Health plans utilization and case management programs Responsibilities:• Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. - Work most often impacts a large business unit or multiple markets/sites.• Directs others to resolve business problems that affect multiple functions or disciplines. Product, service or process decisions are most likely to impact multiple functions and/or customers accounts (internal or external).• Develops and implements the organization’s utilization management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, and accreditation standards• Develops and implements systems, for all utilization and case management policies and procedures including prospective, concurrent and retrospective case review, clinical practice guidelines, clinical protocols, and reporting quality of care issues identified during the utilization review process• Educates and trains the leadership, staff, and business associates as to the utilization management plan and their respective responsibilities relative to the plan• Collects, analyzes, and maintains data on the utilization of medical services and resources• Prepares and presents quarterly utilization management summaries to the QMC, identifying potential areas for improvement• Reports quality of care issues identified during the utilization review process according to policy and procedure• Actively participates or facilitates selected committees such as Utilization Management and Performance Improvement

• Licensure as a RN, in the State of Tennessee

• A bachelor’s degree in a clinical field and/or a minimum of three years experience in utilization management, health information management, nursing, quality improvement, or a related field

• Knowledge of statistics, data collection, analysis, and data presentation

• Excellent interpersonal communication and problem-solving skills

• Knowledge of utilization management techniques

• Knowledge of ICD and CPT coding

When you become part of AmeriChoice, you also become part of something larger—a Fortune 100 leader with a broad spectrum of services and products—while still working for a company where you can see and feel your impact. It's the best of both worlds. If this is not the right opportunity for you at this time, please share it with the people you know who could excel in this role, and keep looking for the right opportunity for yourself at UnitedHealth Group.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V