The Director of Clinical Operations 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. The Director of Clinical Operations may also be responsible for providing health education, coaching and treatment decision support for members. In the Nevada market, the Director of Clinical Operations will also have client management responsibilities.
Major Responsibilities include :
Strategize, develop and direct operations of the health services department to ensure provision of high quality, cost-effective medical service
Responsible for the development and management to budget related to medical care, direct actions to achieve program metrics and value proposition for the clinical programs in Nevada
Development of site budget in conjunction with Regional President
Client management: conduct monthly joint operating committee meetings with client; reviewing operational and clinical metrics and client value report
Ensure compliance with State and Federal regulations, compliance with company policies and procedures.
Form internal and external strategic relationships which will support program expansion and continuing success
Provide leadership to and be accountable for the performance of managers and/or senior level professional staff.
Develop and routinely update comprehensive medical management work plans/programs for all programs.
Review periodic reports (financial/utilization/services) analyze trends and implement timely corrective action plans
Review and implement medical management policies and procedures to ensure compliance with the State and Federal regulations
Strategize and implement a clinical model which is focused on quality, reduces medical cost appropriately and which incorporates the skills of provider partners whenever possible
Direct the development of well designed processes which when fully implemented, will be evident in daily work flows which are efficient and support the achievement of the site goals.
Conduct regular meetings with staff to address issues, concerns, and to communicate corporate and site-specific philosophy.
Oversee the integrity of the patient-data base system to ensure consistency in the data entry and the integrity.
Coordinate plans with the local and national quality committee to comply with regulations and accreditation agencies.
Strategize and identify opportunities for expansion of Optum Complex Population Management to other payers in the state of Nevada
Strategize with the senior staff about program expansion/development/new models/new alliances.
Implement new programs or new care models.
Staff Retention and Development
Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance and minimizes staff attrition while meeting budget requirements.
Direct the orientation, training, and on-going education and skill development of the institutional health services staff.
Conduct routine meetings with staff to address issues, concerns, and communicate site and corporate philosophies and directives.
Participate in and lead special project groups which provide skill building opportunities for the participants and allow others to display leadership capabilities.
Nurse Practitioner with current licensure, geriatric certification preferred OR RN with current licensure, BSN preferred.
Master's Degree prepared in nursing, health sciences, social services or business preferred.
3-5 years leadership and management experience in an organization that services the elderly, chronically ill or frail population.
Experience with Medicare, Medicaid and managed care in a variety of health care settings.
Outstanding leadership skills including strategic planning experience
Strong relationship and negotiation skills, budget management experience and regulatory knowledge.
Leadership and management experience in effective team building and continuous quality improvement programs.
Working knowledge and experience in cross-functional business segments and their integrated influences and relationships.
Effective and experienced in motivating and mentoring others who are not in a direct reporting relationship.
Ability to travel locally up to 25% of the time to business meetings
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
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.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier...