Riverside Medical Group is the premier medical practice in New Jersey serving patients in Hudson, Bergen, Passaic, Essex, Middlesex, Burlington, and Camden counties. We have over 60 locations and 180 board certified medical providers specializing in Adult Medicine, Pediatrics, ENT, Foot & Ankle, Gastroenterology, Rheumatology, Cardiology, Behavioral Health, Physical Therapy, Allergy & Immunology, Developmental Health, Pain Management, Chiropractic and Optometry.
 
As a National Committee for Quality Assurance "Level III- Patient Centered Medical Home," Riverside is able to provide patient-focused precision medical care to the entire family and is committed to providing patients with the highest quality medical care.

In addition to providing the highest quality of care, Riverside offers its patients the best hours of operation of any private practice in the country. Patients have around-the-clock access to a health-care team and have the benefit of same day and walk in appointments. As an advocate for prenatal health and education, Riverside offers prenatal classes every weekend free of charge. Riverside believes in giving back to their community and the patients they serve through health fairs, charitable giving/foundation, and free medical education.

As a part of the OptumCare network, Riverside Medical Group is seeking a Certified Medical Assistant 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)

Function is responsible for 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. Manages and is accountable for professional employees and/or supervisors. Impact of work is most often at the local level.

Primary Responsibilities:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions
• Sets team direction, resolves problems, and provides guidance to members of own team
• Serve as a clinical resource and coach for Complex Case, Disease and Transitional Case Management programs
• Onboards all OCNY contracted providers and establishes effective care management workflows and sharing of information between case managers and providers
• Adapts departmental plans and priorities to address business and operational challenges
• Influences or provides input to forecasting and planning activities
• Answer clinical questions from staff and resolving client issues
• Provide ongoing training and education on clinical knowledge
• Handle escalated issues when necessary
• Provide updates and conducting meetings with clients as needed
• Maintain staff levels, interviewing, and hiring employees and enforcing disciplinary actions
• Conduct employee performance reviews
• Conduct call monitoring and case auditing of staff, and implementing performance improvement plans
• Ability to work in a fast-paced environment
• Independently serve as the clinical liaison with hospital, clinical and administrative staff within our documentation system for discharge planning and/or next site of care needs.
• Establish process for care team to make referrals to community sources and programs 
• Facilitate complaint process by engaging member, family, and caregivers telephonically
• Establish a process for member education to assist with self-management goals, disease management or acute condition
• Utilize evidenced-based practice to develop interventions 
• Establish a process to utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Manage quality of clinical assessments and Care Plans 
• Oversee Interdisciplinary Care Team (IDCT) process 
• Coordinate regular clinical reviews of high-risk cases with members of the Interdisciplinary Care Team (IDCT)
• Ensure adherence to relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual) for Complex Case, Disease and Transitional case management.
• Demonstrate understanding of utilization management processes
• Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
• Monitor staff caseload in an efficient and effective to ensure optimal productivity 
• Monitor and ensure timely and accurate documentation in the care management electronic software system to comply with documentation requirements and achieve individual and collective audit scores of 95% or better on a monthly basis
• Monitor staff licensure, certifications, and annual training are maintained and compliant
• Attends meetings and participates on committees as requested
• Identifies opportunities for process improvement in all aspects of member care
• Supports data collection and closing of care gaps and quality metrics as assigned, and assists the healthcare team in meeting quality metrics 
• Must maintain strict confidentiality at all times
• Must adhere to all department/organizational policies and procedures
• May oversee work activities of other supervisors
• Performs all other related duties as assigned

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:

To perform this job successfully, an individual must have the following education and/or experience.

• Current, unrestricted RN license required, specific to the state of employment
• Bachelor of Science in Nursing 
• 3+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management 
• 1+ years of recent leadership experience (manager, supervisor, team lead, etc.), with ability to partner with staff to build high-performing teams.
• 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)
• People-management experience, to include motivational leadership, ability to implement performance improvement plans, and a drive to see employees succeed in their work
• Experience managing direct reports to performance metrics
• 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:

• 5+ years of managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management experience
• 3+ years of recent leadership experience (manager, supervisor, team lead, etc.), with ability to partner with staff to build high-performing teams.
• 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

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.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to 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.