For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The Director, Medical Services will have a primary responsibility for ensuring delivery of cost effective quality care that results from effective utilization management and medical operations, and care coordination. The Director will also be responsible for the implementation and oversight of medical operations related to new and current services offered under the Idaho Behavioral Health Plan program incorporating recovery, resiliency and person - centered services. Responsibilities also include oversight of care management staff, treatment protocols and philosophies (including those that address consumer cultural preferences). The Director will also provide oversight and monitoring of service trends and improvement plans for the Optum Idaho operation as well as interdisciplinary work with internal departments on medical best practices. Primary Responsibilities:Conduct Utilization Management based on Medical Necessity Monitor the Quality of Services provided by the Optum Idaho Network of Providers Conduct Inter - rater evaluation of Peer Review Services Monitor Adverse Benefit Determinations and Provider concerns Provide Clinical Guidance for the development of new services (Intensive Outpatient, Respite, Child and Family Teams etc.) Consult with the Field Care Coordinators Participate in Behavioral Health Consultations, Clinical Case Reviews, and Multidisciplinary Staffing's when requested Others as assigned
Required Qualifications:Minimum of current Licensed Independent Practitioner (Psychiatric Nurse Practitioner) required Minimum of 5 years operational and clinical experience required Minimum of 3 years of experience working with community based programs and resources designed to aid the Idaho Medicaid population and health care system overall required Demonstrate understanding of relevant medical practice regulations (e.g., State Board Nursing; Medical / Clinical Practice; Board of Pharmacy; Medical Board of Examiners; CMS) required Minimum of 2 years of Leadership experience strongly preferred Demonstrate understanding of managed - care entities (e.g., ACO; CCO; HMO) a plus Demonstrate understanding of state, federal, and private healthcare guidelines, regulations, procedures, and products (e.g., Medicare / Medicaid; HIPAA; MIPAA) Capacity to establish accreditation and audit readiness, monitor efficiency and productivity, and provide internal and external reporting to demonstrate value of care and utilization management for health care commercial or government business Familiarity with NCQA and URAC standards and organized accreditation review for medical programs Knowledge of post - acute care planning such as home care, discharge planning, case management, and disease management Minimal local travel requiredCareers with Optum. 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. Optum, 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) 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. Keywords: Medicaid, Operations, Psychiatry, Behavioral, Medical
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.