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UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Director of Clinical Operations
Location
United States
Posted
85 days ago
Salary
$134K - $230K / year
Seniority
Lead
No structured requirement data.
Job Description
Director of Clinical Operations
UnitedHealth Group
Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs — helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients at home, nursing homes and assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together. As a team member of our Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. The market DCO provides leadership and is accountable for the performance of a team of CSMs. In collaboration with the RVP, the DCO will strategize, develop, and direct operations of the of the health services department to ensure that the provision of high quality, cost-effective medical services are delivered to membership. Primary Responsibilities: - Development and management of budget related medical care - Works with the site medical expense team to provide direction for actions to control targeted costs for inpatient and outpatient services - Ensure compliance with State and Federal regulations, as well as company policies and procedures - Oversee the integrity of the patient-data base system to ensure consistency in the data entry and integrity - Coordinate plans with the local and national quality committee to comply with CMS regulations and National accreditation agencies - Strategize with the senior staff regarding: - Program expansion - Business development - New models - Collaborate cross-functionally to meet site business goals and objectives - Engage and drive all staff in implementing activities to meet business goals - Implement and support new programs and/or new care models - Participate in and lead special project groups that provide skill building opportunities for the participants, and allows others to display leadership capabilities Communication and Relationships: Leadership Adeptness: Staff Performance, Retention and Development - Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance, and maximizes staff retention while meeting budget requirements - Directly lead, supervise, and develop a team of CSM’s - Maintain overall accountability for clinical team development and performance - Direct the orientation, training and ongoing education and skill development of the health services staff - Conduct regular agenda driven meetings with staff to address issues, concerns, and to communicate corporate and site-specific philosophy - Promotes United culture to ensure succession planning Revenue Accuracy and Medical Management - Develop and routinely update comprehensive medical management work plans/programs for the site - Lead the medical expense data analyses - Determine required improvement efforts for the site, based on outcomes relative to targets and budgeted matrices - Strategize and implement the clinical model. Focus on quality, to appropriately reduce medical cost while incorporating the skills of provider partners whenever possible - Focus on quality improvement and clinically appropriate utilization, while incorporating the skills of provider partners Program Quality: - Coordinate quality program and contractual requirements, maintaining compliance with regulatory and accreditation requirements - Direct the development of well-designed processes, which will be evident in efficient daily work flows that support the achievement of business goals - Direct the integration of the local quality assurance committee activities - Identify any quality issues and implements quality initiatives for improvement - Use reports and other available materials to analyze performance & gaps (know your numbers) - Develop & support implementation of corporate & local processes to support Quality Improvement (QI) and to achieve business goals - Identify system level opportunities to support QI - Provide clinical support and education - Hold team responsible for progress in prioritized areas - Share best practices across the organization through participation on workgroups Internal and External Strategic Partnerships - Implement a program to address the needs of the marketplace - Strategize and evaluate methodologies for program adaptation and integration within partnering organizations - Conduct regular agenda-driven meetings with selected partners to promote program visibility, and to support a dynamic, results-oriented relationship with selected organizations, contracted facilities, or associated consortium or corporation Staff Performance, Retention and Development - Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance, and maximizes staff retention while meeting budget requirements - Directly lead, supervise, and develop the health services leadership team - Maintain overall accountability for clinical team development and performance Professionalism: - Personal and Professional Accountability: - Create an environment that facilitates the team to initiate actions that produce positive results - Ability to hold self and others accountable for actions and results - Answers for one’s own behavior and actions - Career Planning: - Develops own career path - Coach others in the development of their career planning - Create an environment in which professional and personal growth are an expectation. - Ethics: - Integrate high ethical standards and UHG core values into everyday work activities 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: - RN degree certified through a national state board and with active license - Active and unrestricted license in the state which you reside - 5+ years of leadership and management experience in an organization that serves the elderly or chronically ill population - Experience with Medicare, Medicaid and managed care in a variety of health care settings - Leadership and management experience in effective team building and continuous quality improvement programs - Proven solid negotiation skills, budget management experience and regulatory knowledge - Proven ability to work across functions and businesses to achieve business goals - Proven effective in motivating and mentoring colleagues and peers - Driver’s license and access to reliable transportation Preferred Qualifications: - Master’s degree; ideally in nursing, health sciences, social services or business - 3+ years of experience at Optum - Leadership and management experience in a SCC market as a CSM or Sr. CSM with success in effective team building and quality improvement - Knowledge and understanding of geriatrics clinical management - Proficient in excel - Proficient computer skills - Proven ability to develop and maintain positive customer relationships - Proven ability to quickly adapt to change and drive change management within team and market - Proven high level of organizational skills, self- motivation, and ability to manage time independently *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 $134,600 to $230,800 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.
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