Director, Population Health and Medical Management OCNJ
Location: Secaucus, New Jersey
Internal Number: 106770553
Riverside Medical Group is the premier medical practice in New Jersey serving patients in Hudson, Bergen, Passaic, Essex, Middlesex, Burlington, and Camden counties. We have over 60 locations and 180 board certified medical providers specializing in Adult Medicine, Pediatrics, ENT, Foot & Ankle, Gastroenterology, Rheumatology, Cardiology, Behavioral Health, Physical Therapy, Allergy & Immunology, Developmental Health, Pain Management, Chiropractic and Optometry.
As a National Committee for Quality Assurance "Level III- Patient Centered Medical Home," Riverside is able to provide patient-focused precision medical care to the entire family and is committed to providing patients with the highest quality medical care.
In addition to providing the highest quality of care, Riverside offers its patients the best hours of operation of any private practice in the country. Patients have around-the-clock access to a health-care team and have the benefit of same day and walk in appointments. As an advocate for prenatal health and education, Riverside offers prenatal classes every weekend free of charge. Riverside believes in giving back to their community and the patients they serve through health fairs, charitable giving/foundation, and free medical education.
As a part of the OptumCare network, Riverside Medical Group is seeking a Certified Medical Assistant to join our growing team in New Jersey. At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life's best work.(sm)
Position in this function Leads clinical and administrative operations for Optum care of New Jersey (OCNJ) Population Health and Medical Management Department. Function is responsible for directing clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). This includes case management, coordination of care, and medical management consulting, health education, coaching and treatment decision support. Establishes effective partnerships with hospitals, skilled nursing facilities, home care agencies and other community-based organizations to develop a network for provision of high quality of care. 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.
Direct the clinical and administrative operations and promote growth and development of staff
In coordination with VP of Medical Management responsible for growth and development of the population health management and medical management programs
Work closely with VP of Medical Management and Medical Director to execute on all initiatives, new programs and goals
Understand client goals, expectations, and objectives that drive a positive member and client experience as well as obtain compliant outcomes and maintain fiscal responsibility
Understand service and provider platforms and act as a subject matter expert (SME) to support projects, regulatory issues, and initiatives
Drive utilization and affordability initiatives through strategic actional planning and execution within the region
Ensure market compliance with all federal and state regulations, accreditation organizations, and client requests
Provide oversight of clinical team activities, staff development, budget management, regulatory compliance, and audit readiness
Conduct employee performance reviews
Remain accountable for all operational plans, produce and report key metrics, and conduct regular clinical operational meetings
Cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
Collaborate with internal and external business partners to maintain all contractual performance guarantees
Drive programs/project implementation on time and within budget while securing necessary resources
Delegate escalated clinical decisions and patient facing recommendations to Clinical Managers
Manage clinical utilization and outcomes activities within the assigned market
Collaborate with peers and staff to ensure the understanding and execution of operational and business requirements
Manage and innovate with peers in areas such as quality, product, training, health services, compliance, network, and all others across the organization
Set the example of team collaboration as well as clinical collaboration throughout other regions
Perform other duties and responsibilities as required, assigned, or requested
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.
Bachelor of Science in Nursing, Healthcare Administration, or a related field
Current, unrestricted RN license required, specific to the state of employment
10+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management
5+ years of recent leadership experience with ability to partner with staff to build high-performing teams
Experience managing direct reports to performance metrics
Expert knowledge of case management principles, as evidenced by certification in Case Management (CCM) or willing to obtain within 6 months of employment
Knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual)
Proficient with Microsoft Office applications including Word, Excel, and PowerPoint
Willing to occasionally travel as deemed necessary
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Master of Science in Nursing, Healthcare Administration, or a related field
15+ years of managed care, Complex Case Management, Disease Management and Transitional Case Management experience
Knowledge of utilization management, quality improvement, and discharge planning
Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
Solid communication and interpersonal skills
Demonstrated ability to work in a fast pace, multi-tasking team environment while meeting deadlines
Highly skilled in leading change efforts and in building strong partnerships with business-line executives
Ability to summarize complex issues and problems into a concise report focused on key findings and outcomes
Ability to consistently manage up and down
Ability to complete initiatives with minimal supervision
Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives
Demonstrated sophisticated written and verbal presentation abilities; experience with the development of presentation materials (collateral, proposals, presentations, talking points, etc.)
Proven proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project/requested timelines
Solid leadership skills, demonstrated by the ability in leading large teams of individuals to successful outcomes
Physical & Mental Requirements:
Ability to lift up to 25 pounds
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Opportunities with Riverside Medical Group. Discover what it means to be part of a top-rated, premier medical practice with a deep commitment to serving its community for over 35 years. We’re also part of the best hospital system in New Jersey and one of the best 50 hospitals in the nation. Riverside Medical Group has over 25 locations in Northern New Jersey, and we deliver quality-focused care to patients of all ages. We recently became part of OptumCare - the health care delivery part of Optum, backed by the scale and resources of the UnitedHealth Group family of companies. Every day we provide the ultimate patient experience through round-the-clock access to health care teams, same day and walk-in appointments, as well as charitable giving and a foundation that supports scholarships and medical research. At Riverside, you’ll play an important role in helping people achieve optimal health, and that’s just the start. Learn more about career opportunities with Riverside Medical Group, where you can help change the world as you do your life’s best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.