Foster care case manager Jobs in Augusta, GA

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The C&S Plan Associate Medical Director is accountable for ensuring top performance in clinical quality and ratings improvement, appropriate inpatient and outpatient covered-service utilization, and health care affordability for Medicaid and the Georgia Foster Care Programs. The Associate Medical Director is expected to help drive integrated health system transformation by working with facilities, provider groups, and provider organizations to address issues with and improve provider network engagement. The Associate Medical Direct will support the health plan with contractual provisions, compliance, growth strategies and develop / lead focused improvement projects that are implemented and successfully managed to achieve goals.

This position reports to the Community and State plan Chief Medical Officer with a dotted line relationship to the Executive Director of Clinical Transformation. The Associate Medical Director’s primary responsibilities are monitoring utilization management, appeals and grievances activities, as well as provider quality of care. The C&S Plan Associate Medical Director collaborates within the health plan as a subject matter expert with population health, quality, and operations teams as well as our shared service partners such as the provider engagement team. The Associate Medical Director may support the implementation programs to meet market needs or business goals. In addition, the Medical Director would service as a subject matter expert in quality initiatives and special projects.

The Assistant Medical Director must be located within the state of Georgia. You will have the flexibility to work remotely.

If you are live in Georgia, you will have the flexibility to work remotely

• as you take on some tough challenges.

Primary Responsibilities :

Oversight of health plan utilization management and appeals and grievance processes – The Associate Medical Director is the accountable owner for all Medicaid utilization management processes as well as appeals and grievances. This includes having a working relationship with the various teams in United Clinical Services as well a coordination of state lead changes which impact our clinical functions

Clinical Excellence, Quality Standards and Service Performance - The Associate Medical Director contributes to the HEDIS and STARs process improvements and performance strategy, CAHPS and NPS improvement strategies and support necessary Health Plan accreditation activities; the Associate Medical Director is required to help achieve or exceed all applicable HEDIS, Stars and local state performance targets and goals. The Associate Medical Director should act as an improvement catalyst for all service and quality-related efforts by influencing, participating, and communicating to the value-based program leads, network providers, or vendors the quality goals of the health plan. The Medical Director will participate regularly in clinical rounds providing clinical insight and leadership to teams while ensuring that quality and standards of care are maintained. The Associate Medical Director supports the peer review processes including Quality of Care and Quality of Service (grievance) issues and is responsible for representing the health plan and the state Medicaid partner at State-level Fair Hearings and performing plan-level member / provider grievance and appeals reviews. They will also actively lead Provider Affairs Subcommittee (PAS), Quality Management Committee (QMC) and other associated quality and / or member / provider service-focused committees

Affordability and Quality of Care - The Associate Medical Director assists the CMO to meet affordability targets for optimal medical performance. This work is done with the Chief Medical Officer, Chief Financial Officer, and the Health Care Economics teams. This work includes using dashboards and other clinical data, looking at trends aligning these findings to the landscape of the healthcare system. In addition, the Associate Medical Director will both bring forth and execute affordability initiatives for the health plan with the advisement of the CMO

Drive Quality in our Provider Partnerships : This works requires a close working relationship with the plan CMO, the Executive Director of Clinical Transformation, and the Vice Presidents of Quality, Population Heath, and Operations. Activities may include conducting Joint Operations Committee meetings with providers, in coordination with shared service partners, contributing to and implementing programmatic and strategic decisions, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. The Associate Medical Director will support the CMO for medical dental, pharmaceutical, and or social initiatives and quality programs as required to achieve the appropriate utilization, affordability, HEDIS and Star goals of the C&S Health Plan. The Associated Medical Director is accountable for building and leaning into relationships with internal and external partners to meet or exceed market requirements

Relationship Equity and State Compliance-The Plan Medical Director maintains a solid working knowledge of all government mandates and provisions for the local C&S market, as well as working across the enterprise to implement and maintain compliant clinical programs and procedures. They participate as a SME in reviewing work plans and in operational reviews and audits. The Associate Medical Director will engage with the Georgia provider community, medical and specialty societies, the state regulator, and other managed care organizations. The Medical Director will work collaboratively in these activities as a representative of the health plan

Leadership Expectations :

Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement, and leveraging diversity and inclusion

Foster solid working relationships within health plan leadership and the shared service partners

Develop and mentor others while also building awareness to your own strengths and development needs

Communicate and present effectively, listen actively and attentively to others, and convey genuine interest

Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to do so

Drive sound and disciplined decisions that drive action while effectively using financial knowledge and data to manage the business

Manage execution by delegating work to maximize productivity, exceed goals, and improve performance

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 :

Georgia active / unrestricted Licensed Physician; must reside in the State of Georgia

Active Board Certification

Familiarity with current healthcare landscape medical issues and practices

Basic understanding of Medicaid, Foster Care health plans

Proficiency with Microsoft Office applications

Clinical, professional interest in special needs populations and fully integrated healthcare models

Willingness to travel locally, in Georgia, to communities where clinical partnerships require face to face interactions

Proven excellent interpersonal communication skills

Preferred Qualifications :

5+ years clinical practice experience; solid knowledge of managed care industry and the Medicaid line of business

2+ years Quality management, Utilization Management, and / or Appeals and Grievance experience

Understanding of Utilization Management and Appeals and Grievances

Proven solid leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization

Proven superior presentation skills for both clinical and non-clinical audiences

Proven ability to develop relationships with network and community physicians and other providers

Proven solid data analysis and interpretation skills; ability to focus on key metrics

Proven solid team player and team building skills

Proven creative problem-solving skills

Skills, Experiences, Qualifications :

Ability to support and contribute to a team that values organizational and plan success.

Demonstrate proactive, solution-oriented approaches to work efforts and drive disciplined, fact-based decisions.

Execute with discipline and urgency : drive exceptional performance, closely monitor execution, and ensure accountability for results.

Drive change and innovation though continually seeking and implementing novel solutions.

Model and demand integrity and compliance with all company policies, and local, state, and federal regulations.

Proven ability to execute and drive improvements in alignment with company and state goals.

Ability to develop relationships with network and community physicians and other providers.

Visibility and involvement in medical community.

Ability to successfully function in a matrix organization exhibiting the culture of UnitedHealthcare.

The salary range for this role is $269,500 to $425,500 annually based on full-time employment. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.