DIRECTOR HEALTH SERVICES - KANSAS

Executes the delivery of Oversight and Monitoring of all Clinical Programs (Utilization Management, Case Management/Service

Coordination and Disease Management) for the Health Plan(s) For the State of Kansas

Ensures local clinical processes, policies and procedures meet regulatory/NCQA/CMS standards and are consistent with State and

Federal guidelines and national policy

Ensures monitoring and oversight of clinical programs/staff to meet defined goals/targets, contract requirements

Works collaboratively with providers, sister-segments, service contractors and health plan management to provide contractual

oversight a health services department with the objectives of ensure contractual obligations and policy are met for members in a

range of products, i.e., Medicaid, CHIP, SSI/ABD, long term care, and dually eligible categories, improving cost efficiencies, and

developing an environment of operational excellence.

Interfaces with UHG enterprise to ensure clinical operations are compliant with State and Federal regulations

Develop and utilize timely and meaningful monitoring reports to assess Health Services performance

Proactively develops and implements staff retention and engagement program

Serves as part of the Health Plan(s) Executive Leadership and regularly interacts with Health Plan Senior leaders and State on

clinical services issues

Ensures clinical staff training, onboarding, immersion and competency assessment processes meet contract requirements and

clinical model standards

Coordinates and provides contractual oversight for all clinical programs delivered by multiple business segments/external vendors

to ensure Health Plan goals are met

Communicates best practices, barriers and potential solutions when operational processes or clinical programs are not delivering

results

Masters in Nursing, Business, Healthcare Administration Preferred

Bachelors in Nursing/ Registered Nurse licensure

Significant experience in development and execution and oversight of clinical programs (CM/UM/DM) in public sector managed care environment (5 years)

Clinical experience with Medicaid/Medicare populations

UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system


If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.



This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.



You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.



Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.