Clinical Program Manager - Remote in New York

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.

This position is remote and candidate manages a team of at least 20 to 22 staff in size responsible for utilization review / case management in a call center environment.  Team is responsible for utilization review / case management of inpatient and outpatient Behavioral Health services and determining medical necessity could have oversight of case management staff that work directly with members telephonically and in the field.  This is a Monday - Friday role but may require some holiday work.

Position provides clinical and medical management services, including case management, health assessments, interventions and discharge planning. May identify, coordinate or provide appropriate levels of care under the direct supervision of an independent licensed clinician.

If you are located in New York, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Oversight of utilization management of adults, adolescents and children as well as dual eligible Medicare/Medicaid populations with SMI, SUD, co-occurring physical health, co-occurring disorders of MH and SUD, and co-occurring mental health and/or substance use disorders
• Oversight of utilization management must be an Independently licensed clinician in the state of New York with experience working in a Behavioral Health managed care setting or Behavioral Health clinical setting and knowledge of Behavioral Health rehabilitation and recovery services
• Manages and is accountable for professional employees and supervisors
• Sets team direction, resolves problems and provides guidance to members of team
• May oversee work activities of other supervisors
• Adapts departmental plans and priorities to address business and operational challenges
• Influences or provides input to forecasting and planning activities
• Oversight of new product implementations
• Initiating process for state initiatives and directives
• Updating and creation of Quick Reference Guides
• Oversight and coordination of care with internal and external partners
• Familiarity with and experience Interfacing with regulatory agencies
• Interview, hire and onboard new employees
• Review reports for team members to insure adherence to established benchmarks
• Provides coverage for management team as needed
• Fosters relationship with leadership and medical directors

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:

• New York active and unrestricted Master's level professional independent license in one of the following: Licensed Clinical Social Worker (LCSW); or Licensed Mental Health Counselor (LMHC); or Licensed Psychologist, OR Registered Nurse (RN) with 5+ years of Behavioral Health experience
• 6+ years of CUD and BH experience
• 5+ years of experience with the Child Adolescent population
• 2+ years of supervisory experience and extensive skills in working with the public
• Experience in the state of New York mental health and substance abuse services delivery system
• Experience working in a managed care organization (MCO)
• Experience with Medicare and Medicaid regulations
• Knowledge of principles and practices of public and commercial mental health service delivery systems
• Flexibility with working evenings, weekends, and holidays

Preferred Qualifications:

• Experience working with the New York provider network
• Knowledge of evidence-based, best and promising practice methods and procedures and solid customer service orientation
• Familiarity with Prior Authorization process and requirements
• Demonstrated competence in clinical care management, solid leadership and organization skills; interpretation of State and federal laws and regulations relevant to the mental health program area
• Proficiency in Microsoft applications
• Dedicated work area established that is separated from other living areas and provides information privacy
• Have access to high-speed internet (DSL or Cable)  

*All employees working remotely 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 $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.