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Manager Clinical Operations

Position in this function is responsible for the oversight and coordination of all activities in the Primary Care Plus (PCP) Clinic.  Develop, implement and monitor systems, procedures and processes required of a recognized Patient Centered Medical Home.  Provides leadership and management skills to enable the clinic to meet its goals and objectives within a profitable, efficient, safe and effective working environment.

 

The Clinic Manager performs a wide variety of duties and responsibilities as well as project assignments and is responsible for the day-to-day operations of the clinic.  Will apply knowledge of concepts, practices and procedures related to clinic and revenue cycle management to serve the needs of the clinic.  Serves as the liaison between the clinic and corporate staff and functions including, but not limited to, policy/procedure implementation, accounts payable, accounts receivable, and compliance.

 

This is an On-Site position located at our clinic in Metairie, LA Monday through Friday 8am until 5pm CST. You must reside within a 25-mile radius of Houma, LA for consideration.

 

Primary Responsibilities:

• Principal Responsibilities
  • Provide administrative supervision of clinical staff, medical records, reception, and other clinic staff to ensure the effective implementation of patient services
  • Ensure that the environment of care meets or exceeds all federal, state and accreditation standards and that a safe environment is maintained for staff, patients and visitors
  • Ensure that all equipment is in good working order and that supplies are maintained at efficient levels.  Recommend needed additions/deletions
  • Assist in developing, implementing and keeping current operational policies and procedures for all clinic and revenue cycle processes
  • Manage all staff training on clinic policies and procedures
  • Works with Primary Care Plus Revenue Cycle Management staff to insure proper collection and reporting of all revenues, adjustments, expenses, bad debts and contractual allowances
  • Manages patient volume to ensure maximum revenue performance
  • Ensuring all clinic expenses are aligned with operating budget
  • Reviews monthly financial statements with the Finance Department
  • Assist in developing and reviewing reports from practice management systems
  • Provide assistance, support, and consultation to assist staff in the full utilization of implemented clinical information and practice management systems
  • Assist with the development of business plans, strategic marketing plans to achieve goals/objective to promote the growth and success of the clinic
  • Be an ambassador for the clinic in building the image, foundation, culture and core values of a Patient-Centered Medical Home (PCMH) practice
  • Attend meetings, seminars, workshops and conferences as needed to stay current in clinic operations and standards of care in the community
  • Facilitate interactions between clinic staff and PCP Corporate office
  • Provide oversight of all Quality Improvement activities
  • Conducts and/or coordinates Patient Satisfaction survey results, reviews, assessments and other ‘outcomes’ activities to ensure quality of care for all clinical programs
  • Maintain confidentiality in all matters
  • Assist with all compliance and internal audit requirements
  • Perform other duties as assigned
• Management Responsibilities
  • Monitor both department and individual staff performance, providing ongoing feedback
  • Maintain appropriate staffing levels required to meet departmental goals
  • Interview candidates and makes hiring decisions as needed
  • Identify opportunities for staff development and coordinates training as needed
  • Ensure staff members meet all required licensing, compliance and continuing education requirements
  • Complete timely and thorough evaluations of staff
  • Function as a mentor to staff regarding career goals
  • Proactively manage employee relations issues, utilizing a progressive corrective action plan including appropriate documentation
  • Serve as a resource to other managers regarding issues that impact their departments
  • Develop, manage and work within department budget
  • Ensure compliance by maintaining knowledge of industry trends and legislation related to department
  • Participates in the timely review and updating of departmental policies, procedures, training manuals and job descriptions as needed
• Core Competencies
  • Leadership – inspires and motivates others to perform well; leads by example
  • Negotiation and Influential Ability – influences decisions in matters related to department to ensure corporate and departmental needs are satisfied
  • Management skills – includes staff in planning, decision-making, facilitating and process improvement; makes self available to staff, provides regular feedback, and develops staff’s skills – encouraging growth
  • Analytical/problem solving skills – identifies and resolves problems in a timely manner and gathers and analyzes information skillfully
  • Judgment – displays willingness to make decisions, exhibits sound and accurate judgment and makes timely and appropriate decisions
  • Planning/organizational skills – prioritizes and plans work activities, uses time efficiently and develops realistic action plans
  • Oral/written communication skills – speaks and writes clearly and persuasively in positive or negative situations.  Demonstrates group presentation skills when conducting meetings, leading a team or working with peers
• Supervisory Responsibility
  • Supervises all clinic staff

Senior Investigator – Remote

The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. Responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

If you reside in the state of Ohio, you will have the flexibility to telecommute* as you take on some tough challenges.

Schedule: Monday-Friday 8:00am – 4:30pm EST

Primary Responsibilities:

• Assess complaints of alleged misconduct received within the company
• Investigate medium to highly complex cases of fraud, waste and abuse
• Detect fraudulent activity by members, providers, employees and other parties against the company
• Develop and deploy the most effective and efficient investigative strategy for each investigation
• Maintain accurate, current and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Communicate effectively, including written and verbal forms of communication
• Develop goals and objectives, track progress and adapt to changing priorities
• Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste and abuse to appropriate federal or state government regulators
• Comply with goals, policies, procedures and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings

What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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’s Degree or Associate’s Degree with 2+ years of equivalent work experience and healthcare related employment
• 2+ years of experience in health care fraud, waste and abuse (FWA)
• 2+ years of experience in state or federal regulatory FWA requirements
• 2+ years of experience in analyzing data to identify fraud, waste and abuse trends
• Intermediate level of proficiency in Microsoft Excel and Word
• Ability to travel locally (in-state) up to 25% of the time, as needed
• Ability to participate in legal proceedings, arbitration and depositions at the direction of management
• Access to reliable transportation & valid US driver’s license

Preferred Qualifications:

• Specialized knowledge/training in healthcare FWA investigations
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• Demonstrated an intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience
• Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Justice Liaison – Remote

We are seeking a mission-driven and detail-oriented Justice Liaison to lead the implementation of the CMS 1115 Justice-Involved Reentry Waiver and oversee the JUST Health program within UnitedHealthcare. This role is responsible for coordinating care for justice-involved individuals, managing cross-sector partnerships, and ensuring accurate and timely data integration-including oversight of 834 enrollment files and other critical data sources. The ideal candidate will bring a solid understanding of justice system navigation and data-driven program management.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

JUST Health Program Management

• Serve as the primary program lead for the JUST Health initiative, ensuring alignment with state Medicaid goals and waiver requirements
• Coordinate with correctional facilities, behavioral health providers, and reentry organizations to deliver pre- and post-release services
• Monitor program performance, identify gaps in service delivery, and implement continuous improvement strategies

Waiver Implementation & Coordination

• Lead operational execution of the CMS 1115 Justice-Involved Reentry Waiver, including pre-release service delivery and post-release care transitions
• Ensure timely access to services such as MAT, peer support, CHW services, and behavioral health treatment
• Maintain compliance with CMS waiver protocols, timelines, and reporting requirements

Data Management & Integration

• Manage and interpret 834 enrollment files to identify justice-involved members eligible for pre-release services
• Reconcile enrollment data with correctional facility rosters and internal systems
• Integrate data from multiple sources (e.g., Medicaid systems, correctional health records, care management platforms)
• Maintain dashboards and reports tracking member engagement, service utilization, and waiver metrics
• Ensure data accuracy, timeliness, and compliance with HIPAA and CMS standards

Stakeholder Engagement & Training

• Function as liaison between the MCO, correctional institutions, courts, probation/parole, and community-based organizations
• Provide training and technical assistance to internal teams and external partners on waiver workflows, data processes, and justice-involved care coordination
• Represent the organization in state and local workgroups focused on justice-involved populations and Medicaid innovation

 

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’s degree in public health, Criminal Justice, Health Informatics, or related field or 3+ years of equivalent experience such as in Medicaid operations or justice system coordination
• Proficiency in Excel for data linkage tasks and data management
• Proven excellent communication, stakeholder engagement, and project management skills
• Reside in New Mexico
• Driver’s License and access to reliable transportation

 

Preferred Qualifications: 

• Bachelor’s degree and/or 7+ years of experience
• Experience with CMS 1115 waivers, 834 files, and justice-involved populations
• Familiarity with New Mexico’s JUST Health program or similar reentry initiatives

Field Case Manager

You push yourself to reach higher and go further.  Because for you, it’s all about ensuring a positive outcome for our members.  In this role, you’ll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you’ll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients. You will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs.

 

Primary Responsibilities: 

• Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
• Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services
• Manage the care plan throughout the continuum of care as a single point of contact
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team

Expect to spend about 80% of your time in the field visiting our members in their homes or in long-term care facilities. You’ll need to be flexible, adaptable and, above all, patient in all types of situations.

 

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: 

• Four-year degree plus 2+ years of relevant experience
• No degree, 6+ years of relevant social service or case management experience
• 1+ years of experience with MS Office, including Word, Excel, and Outlook
• Bilingual Spanish
• Driver’s license and access to reliable transportation and the ability to travel within assigned territory to meet with members and providers

Preferred Qualifications:  

• LTC Case management experience
• Experience with electronic charting
• Experience with arranging community resources
• Field-based work experience
• Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)
• Background in managing populations with complex medical or behavioral needs
• Experience in long-term care, home health, hospice, public health, or assisted living
• Experience with local behavioral health providers and community support organizations addressing SDOH (e.g., food banks, non-emergent transportation, utility assistance, housing/rapid re-housing assistance, etc.)

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Client Service Analyst

Great sales are the result of solid purpose, conviction and pride – pride in your ability and your product. UnitedHealth Group offers a portfolio of products that are greatly improving the life of others.

If you are located within a commutable distance to New York, NY, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities:

• Manages ongoing contract relationships and service delivery to clients for one or more accounts
• Acts as outward-facing, dedicated resources for assigned accounts, typically with direct client contact (not call center) and large or complex accounts
• Build relationships with employer / group clients (not individual members) and serves as the primary point of contact for overall and day – to – day service delivery
• Represents client internally and coordinates with other functions to implement client systems, complete projects, and address ongoing service needs
• Function includes employees who are dedicated on – site service roles
• Works closely with sales on renewals and upselling, but incumbents do not have specific sales goal accountability or primary responsibility to close sales

What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Currently hold a NY state health insurance license OR willing and able to obtain within 6+ months of hire
• 1+ years of Direct Client Facing experience in health care lines of business (for example Medicare, Medicaid, and Commercial Lines of Business)
• Basic level of proficiency with Microsoft Word (sending and receiving information and creating documents)
• Basic level of proficiency with Microsoft Excel (creating spreadsheets)
• Ability to work from Monday to Friday between 8:00am – 5:00pm and overtime as needed
• Ability to work onsite in NYC 2 days per week
• Access to reliable transportation

 Preferred Qualifications:

• 1+ years of PBM experience