RN Case Management Leader El Paso STAR+Plus

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Service Coordination Manager role provides oversight and direction to service coordination staff, as well as identify process improvements. The Service Coordinator Manager will lead the way in developing, implementing policies and procedures as necessary to ensure timeliness and accurate delivery of non-waiver and waiver services to achieve optimal outcomes for Star+Plus members.

Primary Responsibilities:

• Provides supervision and oversight of service coordination staff
• Participates in interdepartmental meetings to represent service coordination needs, including but not limited to: utilization management, provider relations, operations, finance, quality improvement and member services
• Facilitates orientation and training of service coordination staff and provides appropriate feedback and evaluation of progress
• Establishes goals for performance standards of service coordinator
• Provides ongoing training and development of service coordination staff to achieve performance standards
• Identifies problems / barriers / opportunities for intervention. Provides resolution and revision of plans on an ongoing basis
• Provides analysis and reporting to ensure compliance with HHSC, TDI, UMCC and URAC standards
• Manages field staff productivity goals, member satisfaction and outcomes measures
• Conducts ride-along and telephonic auditing to support a part of staff evaluation and monitoring
• Develops and maintains corrective action plans as identified

Knowledge and Skills:

• Able to apply highly technical principles, concepts, and techniques central to the nursing profession in the case management process; specifically with complex populations and waiver
• Must have excellent written and verbal communication skills, impeccable negotiating skills, ability to interact with a wide variety of individuals, and handle several complex situations simultaneously
• Must have evidence of leadership, creativity, integrity and initiative, and sound problem-solving skills
• Must provide attention to detail and follow up
• Analytical decision making and judgment skills
• Demonstrated ability to function as a clinical care team leader

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:

• Graduate of an accredited school of nursing
• Current unrestricted RN license in Texas
• 7+ years of experience in healthcare with at least 2 years of experience in managed care
• 3+ years of management or supervisory experience in managed care
• 2+ years of experience working with MS Word, Excel, and Outlook
• Experience in managing, evaluating, and composing operational reports
• Experience with electronic charting and review
• Reliable transportation with valid driver's license with good driving record

Preferred Qualifications:

• Bachelor's Degree
• CCM and Rug Certification
• 10+ years of managed health care experience
• 4+ years of experience working with Medicaid Waiver populations
• Field-based work experience
• Star+Plus management/supervisory experience (operational and process improvement)
• Bilingual - Spanish

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.