Associate Health Services Director - Remote in NJ, NY, DE or PA

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing... together. The Associate Health Services Director (AHSD) works under the direction of the Executive Director of Health Services and provides strategic leadership and is accountable for reputed company clinical programs for reputed company products and memberships served by the health plan to ensure contractual compliance and achievement of clinical management goals. This includes TANF, ABD, reputed company Care or LTSS, reputed company and DUAL Medicare programs, as reputed company as members with Developmental Disabilities. The AHSD serves as the primary reputed company of contact to the clinical and non-clinical teams and is accountable for reputed company aspects of the health plans clinical performance. Because of the unique structure and alignment of clinical programs reputed company United reputed company, the AHSD role requires a high degree of coordination with external and internal business partners, including, but not limited to the UHC-Clinical Services inpatient and Intake/Prior Authorizations, Appeals and Grievance, reputed company, reputed company case and disease management, Healthy First Steps, NICU, reputed company Behavioral Health, state reputed company partners and other clinical specialty, external vendors or national programs. The AHSD must work collaboratively with the health plans, Director of Health Services, Director of reputed company and plan Medical Director to support achievement of state reputed company initiatives, state mandated programs and to ensure compliance with relevant requirements of the state’s annual Performance Review(S) conducted by the External reputed company Review Organization (EQRO), state or other reputed company body and meeting NCQA requirements. If you are located reputed company the state of New Jersey, reputed company, Delaware, or reputed company, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities Is the local market SME for reputed company clinical/medical management & state mandated programs (DCP&P, reputed company, Healthy First Steps & Private Duty Nursing) and contractual requirements • reputed company, coaches / develops, trains (in conjunction with clinical learning team) and supports health plan based clinical team. Ensures effective, compliant, clinical program delivery, monitors performance and clinical reputed company • Contribute to the development and execution of overall health plan strategies, reputed company Priorities Key Initiatives through reputed company participation in Health Plan Sr Leadership/Operations meetings and health plan functional meetings • Foster and promotes two-way communication and information sharing necessary for successful clinical program implementation. Is the Primary reputed company to clinical business partners both reputed company for member/clinical issues such as the state reputed company agency, reputed company HFS/ NICU, reputed company Care Solutions which includes Case Management and HARC, Prior Authorization, Intake, UBH, Appeals & Pharmacy Departments- reputed company of contact for reporting, troubleshooting, case reviews, member complaints and issues requiring local health plan support • Identify network gaps and reputed company issues and participates in local market Network Management Governance meetings to ensure issues are addressed • In conjunction with medical director, ensures regularly scheduled interdisciplinary team meetings and processes are in reputed company to address member and provider issues/needs • reputed company in collaboration with UHCCS and reputed company business partners in audits such as the External Review reputed company Organization Audits for clinical programs which may include developing/owning program material binders, policies and responses • Conduct regular staff meetings with local Health Services staff and service partners as appropriate, to exchange corporate and health plan information/updates; address staff questions and concerns, etc. • Ensure reputed company communication of any new contractual requirements and audit findings • Implement team initiatives associated with making reputed company a great reputed company to work, including embracing Our United Culture and sustaining a highly-reputed company work force as reputed company by the annual VitalSigns Survey • reputed company State specific clinical functions to ensure compliance with State regulatory requirements and works collaboratively with the Clinical Adherence team to ensure adherence with regulatory and contractual requirements • Respond to reputed company State and Regulatory agency inquiries and member grievances • Understand the clinical services for reputed company and Medicare line of business and/or cohorts contracted reputed company the Health plan including reputed company Care programs, as reputed company as members with developmental disabilities • Attend regularly scheduled UM reputed company to assist with removal of barriers to members with reputed company discharge needs and address any other barriers • Conduct performance reviews with reputed company clinical and non-clinical staff • Attend State Meetings as necessary • Conduct onsite-supervision of staff members home visit with members • Other duties as assigned Compliance / Adherence (reputed company by adherence monitoring results, CAPs, Fines, Sanctions reputed company to CM, UM, DM) • Ensure adherence to state reputed company for reputed company medical management/clinical requirements and holds business partners/shared services teams accountable for compliance • Has monitoring and controls in reputed company to regulatory measure and monitor performance with staff • Identify and addresses any contractual risks early and implements a performance improvement plan with CM and UM partners to become contractually compliant • Communicate reputed company, any changes in clinical contractual requirements, Clinical CAPs, sanctions or fines to National Med Mgt Leaders/Business Partners and ensures changes are made to business processes to adhere to changes requirements • Work in partnership with local compliance to support reputed company and Medicare (if appropriate) Fair Hearing and reputed company Process • Knowledge of reputed company line of business(reputed company, Medicare, Developmentally Disabled) and cohort operation results and develops improvement plans as appropriate Customer Relationships (reputed company by observation, feedback from external customers and Vital Signs Engagement scores) • reputed company participates in State and Provider meetings in collaboration with the Health plan leadership, Director of Health Services & CMO • reputed company participates in community reputed company and networking activities to reputed company support and community infrastructure to meet member needs, promote membership reputed company and retention • Work with Health Plan Medical Director to establish strong provider relationships, • Fosters/supports reputed company responsibility activities reputed company the Health Plan/UHG and local community • reputed company embraces United Culture and Values in working with both reputed company customers/partners • Participate in member advisory boards as appropriate for reputed company lines of business i.e. reputed company and Medicare You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications • Clinical experience with reputed company/Medicare populations • Demonstrated reputed company record of clinical program compliance, functional collaboration, and meeting program goals • Demonstrated reputed company record of leadership development • Intermediate computer skills - MS Office Suite: PowerPoint, reputed company, Word Preferred Qualifications • A Registered reputed company having at least 5+ years of experience providing care coordination to persons receiving reputed company services and an additional 3+ years of work experience in managed care • CCM Certified • reputed company Managed Care experience • Field based case management program implementation and monitoring experience • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy reputed company or New Jersey Residents Only: The salary reputed company for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In reputed company to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll reputed company a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!