Optum in the tri-state region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group) offers an interconnected network that enables us to work collaboratively to better coordinate care among our doctors and care teams. Together, we offer you and your family access to more than 2,100 providers, representing 70 specialties, working in 360 medical practices and more than 55 urgent care locations across New York, New Jersey, and Southern Connecticut. For more information, visit www.optum.com/tri.

ProHealth is one of the largest private multi-specialty medical practices in the Northeast and has been serving the health needs of Long Island and the Greater New York Metropolitan area since 1997. With over 900 providers in 300 locations, our goal is to provide quality health care to ensure that our patients get the right care at the right time.

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)

In close collaboration with the Vice President, Medical Management and Population Health, assists in leading operations for Optum Tri-State Medical Management and Population Health Department. Function is responsible for optimizing 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 multiple markets/sites.

Primary Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

• In collaboration with VP of Medical Management responsible for implementation, growth and development of the population health management and medical management programs and services across Tri-State markets
• Works closely with VP of Medical Management and Medical Director to implement new initiatives and programs across Tri-State markets
• Evaluates and optimizes the clinical and administrative operations and promotes growth and development of staff
• Understands client goals, expectations, and objectives that drive a positive member and client experience as well as obtain compliant outcomes and maintain fiscal responsibility
• Understands service and provider platforms and act as a subject matter expert (SME) to support projects, regulatory issues, and initiatives
• Assists in driving utilization and affordability initiatives through strategic action planning and execution within the region
• Ensures markets compliance with all federal and state regulations, accreditation organizations, and client requests
• Collaborates with VP of Medical Management and Population Health for oversight of clinical and non-clinical team activities, staff development, budget management, regulatory compliance, analytics and audit readiness
• Conducts employee performance reviews
• Remains accountable for all operational plans, produce and report key metrics, and conduct regular clinical operational meetings
• Cultivates a strong internal culture designed around collaboration, feedback, motivation, and accountability
• Collaborates with internal and external business partners to maintain all contractual performance guarantees
• Drives programs/project implementation on time and within budget while securing necessary resources.
• Collaborates with peers and staff to ensure the understanding and execution of operational and business requirements
• Manages and innovate with peers in areas such as quality, product, training, health services, compliance, network, and all others across the organization
• Sets 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.

Required Qualifications:

• Master of Science in Nursing, Healthcare Administration, or a related field
• 15+ years of managed care, Complex Case Management, Disease Management and/or Transitional Case Management experience
• 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
• Demonstrated ability to cultivate a solid internal culture designed around collaboration, feedback, motivation, and accountability
• Demonstrated ability to work in a fast pace, multi-tasking team environment while meeting deadlines
• Proven skill in leading change efforts and in building solid partnerships with business-line executives
• Proven ability to summarize complex issues and problems into a concise report focused on key findings and outcomes
• Proven ability to consistently manage up and down
• Proven ability to complete initiatives with minimal supervision
  

Preferred Qualifications:

• Solid communication and interpersonal skills
  

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
  

CareMount Medical, ProHEALTH Care Associates, and Riverside Medical Group (the “Practices”) are all physician owned and led practices having complete authority for all medical decision-making and patient care through their physicians and other licensed professionals. Optum, through its management organizations (“Optum”) provides non-clinical administrative services to support the Practices and their physicians. Neither Optum nor its management companies employ, engages, or supervises physicians or other licensed professionals, or determines or sets the methods, standards, or conduct of the practice of medicine or health care provided by the Practices or by any of their licensed professionals. “Part of Optum” reflects that the Practices are part of Optum’s effort to support forward-thinking physician practices in helping their patients live healthier lives.

Careers with Optum . Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

New York Residents Only: The salary range for New York residents is $101,200 to $184,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.