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Supervisor, Regional Care Management

Company: Healthcare Partners
Location: Costa Mesa
Posted on: June 12, 2021

Job Description:

OVERVIEW OF POSITION:

Responsible for overseeing the ancillary care management activities and the daily operations of the inpatient (care coordinators) or outpatient (health advocate, CalOptima personal care coordinators) regionally based care management support team to ensure accurate and timely referral processing, discharge planning, authorizations, outreach and follow-up to support compliance with care management policy, programs and processes as well as regulatory guidelines. Works collaboratively with department management staff to ensure that cross-functional issues are addressed in a timely and efficient manner.

ESSENTIAL FUNCTIONS:

  • Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Provides direct supervision, guidance and professional development to assigned team, including, but not limited to hiring, orientation, ongoing job training, communication and disciplinary counseling.
  • Supervises and works with care management staff to meet auditing timeframes and proactively manages gaps and interventions.
  • Supervises workflow of the care management department within lane.
  • Provides oversight for contracting and benefit eligibility issues (senior and commercial) as requested and ensures that staff verifies eligibility, benefits and co-pays on all requests.
  • Monitors progress of pending requests / tasks and investigates incomplete requests / tasks according to care management policies and procedures.
  • Participates in continuous quality improvement including analyzing work processes and initiates necessary steps to make changes when appropriate.
  • Ensures compliance with CMS/DMHC/NCQA requirement standards.
  • Coordinates provisions to support continuity of care, including but not limited to post acute services.
  • Participates in the development of care management processes with other regions to ensure uniformity across the organization.
  • Ensures compliance with medical group policies and procedures as well as regulatory standards.
  • Conducts and participates in monthly staff meetings.
  • Monitors productivity levels team per department policy.
  • Participates in stewardship of financial resources and budget.
  • Communicates all issues and concerns to management team.
  • Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Performs additional duties as assigned.

EDUCATION:

  • High school diploma, G.E.D. or equivalent. Includes special certification required for specific jobs.
  • Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college preferred.

EXPERIENCE:

Minimum:

  • Over 1 year and up to and including 3 years of experience.

Preferred:

  • 1 to 2 years of managed care/HMO experience in utilization review, case management or discharge planning.
  • 1 to 2 years supervisory or management experience in utilization review, case management or discharge planning.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.
  • Working knowledge of Microsoft applications (Word, Excel, Access).
  • Knowledge of ICD-9 and CPT coding.
  • Working knowledge of CMS, NCQA, DMHC, HEDIS, medical and regulatory agency guidelines.
  • Excellent verbal and written communication skills. Ability to effectively communicate and collaborate with physicians, patient/families and ancillary staff.
  • Strong analytical and problem-solving skills

What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)

Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Healthcare Partners, Costa Mesa , Supervisor, Regional Care Management, Other , Costa Mesa, California

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