Member Transition Manager - Remote in Idaho

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Member Transition Manager has responsibility to provide support and oversight for all transitions of care for people across Medicaid and Medicare programs, enrollment status and care settings. This role will support other Health Services Department team members in supporting care transitions and assist in ensuring care transitions are successful.

This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills.

This is an Idaho-based role and you’ll enjoy the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities

• Supports and oversees transitions of care across Idaho
• Assists in resolving problems and obstacles to discharge
• Adapts departmental plans and priorities to address business and operational challenges
• Monitors, manages and controls operational and performance metrics in conjunction with established program value targets (HEDIS, NCQA, State Contractual Requirements)
• Develops solutions to address new, often complex customer requirements that address operational, clinical and customer needs
• Partners with network relations teams to ensure provider partnerships enable quick and quality transitions
• Ensures audits are conducted, standards are met, successful outcome are achieved
• Reviews operational and performance metrics regularly and drives action plan development and execution
• Ensures health plan remains compliant with all applicable regulatory and accreditation requirements (NCQA and URAC)
• Collaborates across the health plan and with other stakeholders to identify and address specific and systemic challenges/obstacles to successful care transitions
• Other duties as assigned
  
  

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

• Current independent and unrestricted licensure in Idaho as a Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW), Licensed Mental Health Professional (LMHP) or Registered Nurse
• 2+ years of relevant Medicaid health care experience
• 2+ years of Case Management experience
• 2+ years of program or people leadership experience
• Proficient in Microsoft Word, Excel and PowerPoint
• Demonstrated success in transitioning people between residencies (e.g. nursing facility to home
• Resident of Idaho
  
  

Preferred Qualifications

• Certified Case Manager (CCM)
• Field based or Community based experience
• Experience working for an insurance company or other managed care setting
• Experience working with the Medicaid population
• Experience working with the LTSS population
• Experience with vulnerable subpopulations including adults with serious mental illness, members with substance use disorders, and members with other complex or multiple chronic conditions
• Experience with accreditation requirements (NCQA and URAC
• Proven solid team building, leadership and mentoring skill
• Proven ability to communicate with members who have complex medical needs and may have communication barriers
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
  
  

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. 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.

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.