Director of Clinical Operations

UnitedHealth Group•Atlanta, GA

16h

About The Position

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.

Requirements

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

Nice To Haves

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.

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
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
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
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
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
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
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
Integrate high ethical standards and UHG core values into everyday work activities