As a part of the OptumCare network, Riverside Medical Group is seeking a Director of Population Health and Medical Management  to join our growing team in New Jersey. 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)

Position in this function Leads clinical and administrative operations for Optum care of New Jersey (OCNJ) Population Health and Medical Management Department. Function is responsible for directing 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 a large business unit, or multiple markets/sites.

Primary Responsibilities:

• Direct the clinical and administrative operations and promote growth and development of staff
• In coordination with VP of Medical Management responsible for growth and development of the population health management and medical management programs
• Work closely with VP of Medical Management and Medical Director to execute on all initiatives, new programs and goals
• Understand client goals, expectations, and objectives that drive a positive member and client experience as well as obtain compliant outcomes and maintain fiscal responsibility
• Understand service and provider platforms and act as a subject matter expert (SME) to support projects,  regulatory issues, and initiatives
• Drive utilization and affordability initiatives through strategic actional planning and execution within the region
• Ensure market compliance with all federal and state regulations, accreditation organizations, and client requests  
• Provide oversight of clinical team activities, staff development, budget management, regulatory compliance, and audit readiness
• Conduct employee performance reviews
• Remain accountable for all operational plans, produce and report key metrics, and conduct regular clinical operational meetings
• Cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
• Collaborate with internal and external business partners to maintain all contractual performance guarantees
• Drive programs/project implementation on time and within budget while securing necessary resources
• Delegate escalated clinical decisions and patient facing recommendations to Clinical Managers
• Manage clinical utilization and outcomes activities within the assigned market
• Collaborate with peers and staff to ensure the understanding and execution of operational and business requirements
• Manage and innovate with peers in areas such as quality, product, training, health services, compliance, network, and all others across the organization
• Set 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:

• Bachelor of Science in Nursing, Healthcare Administration, or a related field  
• Current, unrestricted RN license required, specific to the state of employment
• 5+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management 
• 15+ years of recent leadership experience with ability to partner with staff to build high-performing teams
• Experience managing direct reports to performance metrics
• Expert knowledge of case management principles, as evidenced by certification in Case Management (CCM) or willing to obtain within 6 months of employment
• Knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual)
• Proficient with Microsoft Office applications including Word, Excel, and PowerPoint 
• Willing to occasionally travel as deemed necessary
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Master of Science in Nursing, Healthcare Administration, or a related field  
• 10+ years of managed care, Complex Case Management, Disease Management and Transitional Case Management experience
• Knowledge of utilization management, quality improvement, and discharge planning
• Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
• Solid communication and interpersonal skills
• Demonstrated ability to work in a fast pace, multi-tasking team environment while meeting deadlines
• Highly skilled in leading change efforts and in building strong partnerships with business-line executives
• Ability to summarize complex issues and problems into a concise report focused on key findings and outcomes
• Ability to consistently manage up and down
• Ability to complete initiatives with minimal supervision
• 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
• Solid leadership skills, demonstrated by the ability in leading large teams of individuals to successful outcomes

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

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Opportunities with Riverside Medical Group. Discover what it means to be part of a top-rated, premier medical practice with a deep commitment to serving its community for over 35 years. We’re also part of the best hospital system in New Jersey and one of the best 50 hospitals in the nation. Riverside Medical Group has over 25 locations in Northern New Jersey, and we deliver quality-focused care to patients of all ages. We recently became part of OptumCare - the health care delivery part of Optum, backed by the scale and resources of the UnitedHealth Group family of companies. Every day we provide the ultimate patient experience through round-the-clock access to health care teams, same day and walk-in appointments, as well as charitable giving and a foundation that supports scholarships and medical research. At Riverside, you’ll play an important role in helping people achieve optimal health, and that’s just the start. Learn more about career opportunities with Riverside Medical Group, where you can help change the world as you 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.