Supervisor, Regional Care Management
Company: Healthcare Partners
Location: Costa Mesa
Posted on: June 12, 2021
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.
- 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
- Supervises and works with care management staff to meet
auditing timeframes and proactively manages gaps and
- Supervises workflow of the care management department within
- 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
- 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
- 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
- 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
- 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.
- 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.
- Over 1 year and up to and including 3 years of experience.
- 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,
- 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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