Director of Home Health Clinical Services

UnitedHealth Group • Corpus Christi, TX

106d • $89,800 - $176,700 • Onsite

About The Position

WellMed, part of the Optum family of businesses, is seeking a Director of Clinical Services to join our team in Mcallen, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The Director of Clinical Services is responsible for the management and supervision of all branch operations including home health for all GSTX markets. They will implement and maintain performance improvement activities and maintains regulatory standards for each branch. This Manager directly and indirectly supervises all members of the branch staff and performs all functions in professional and ethical manner and collaborates with other members of the health care team to ensure quality patient care. The Director of Clinical Services will assure consistent, appropriate, and cost effective care by actively managing patient / client needs, payer's expectations, company policy compliance, and agency financial objectives. They will maintain accountability for achieving financial targets / profitability for the operation by empowering and challenging people, recruiting and training the best people, delivering quality in everything they do, providing the right incentives, providing the resources people need, and creating an environment that enables people to be successful.

Requirements

• Bachelor degree in health or business administration required. (four additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Bachelor's Degree)
• Registered Nurse with 6+ years of experience in clinical leadership / management role
• 2+ years of experience in home health setting
• Recent experience in acute care or home care (within last 2 years)
• Working knowledge of governmental home health agency regulations, Medicare (Medicaid, as required), regulations and company policies and procedures
• Solid organizational, communication, interpersonal skills and reliable transportation
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease

Nice To Haves

• 2+ years of experience in a community health setting
• Demonstrated decision-making skills and solid judgment
• Bilingual speaking (English/Spanish)

Responsibilities

• Directs the daily operations of the GSTX branches (Alice, Corpus Christi, McAllen, and El Paso) to ensure the provision of safe, quality, cost-effective care to patients that contributes to the financial success of the branch
• Regularly evaluates the services and care provided by the branches to ensure compliance with regulatory requirements, company policies and procedures and sound business practices
• Directs the recruitment, hiring, and development of sufficient clinical and non-clinical staff to ensure the delivery of safe and consistent quality care to all patient/clients 24/7
• Assures that clinical caregivers have demonstrated the ability to perform accurate and complete assessments, communicate with physicians, plan for service delivery, plan for discharge, and make excellent professional decisions
• Directs or delegates the assignment of staff, monitoring of daily and weekly schedules, and the matching of caregiver qualifications to patient/client needs
• Manages quality through patient/client care appraisals and employee supervision
• Directs and participates in care coordination activities that effectively coordinate communication regarding patient/client problems, needs, psychosocial and spiritual concerns, and implementation of an individualized, interrelated plan of care
• Manages documentation to ensure that the patient/client's clinical record meets legal and regulatory requirements, facilitates care, enhances the continuity of care, helps coordinate treatment and evaluation of the patient/client, and establishes medical necessity so payers will reimburse for the services that are provided
• Develops and maintains a working knowledge of all services and resources available within the company and the community
• Responsible for interfacing with intake to assure that patient/client's are not admitted for clinical service (case accepted) until they have received an assessment visit and a determination has been made that they are appropriate for home care
• Responsible for annual evaluations of staff according to company policy and procedures and federal/state regulations
• Directs ongoing skill evaluations to assure that the staff's abilities are consistent with the needs of individual patient/clients and the marketplace
• Supervises clinical and operational processes by managing staff and ensuring flow of information and documentation from inquiry through discharge of all patient/clients
• Provides support and documentation needed to facilitate reimbursement
• Assists with the development of an annual market assessment, budget, and business plan and monitors expenditures and adherence to company policies through the implementation of controls
• Assists the Vice President with assessing business opportunities and provides information on costs that can be used in determining the feasibility of pursuing local managed care opportunities
• Schedules staff meetings to communicate with employees, caregivers when appropriate, regarding the needs and concerns of patient/clients and their families, referral sources, clinical updates, policy and procedure changes, and payer sources and the potential for business that these customers represent
• Discusses operational issues to identify issues that may compromise optimal service to customers
• Employs marketing and promotional efforts within the community to support the achievement of sales and earning objectives
• Effectively services all signed contracts
• Implements and maintains Quality Assurance Performance Improvement for the branch by participating in Quality Assessment and Improvement and CHAPs activities and assures participation of all appropriate staff
• Provides information that enables the collection and root-cause analysis of data to identify opportunities for improvement, develops/oversees the development and implementation of action plans that result in continuous quality improvement
• Oversees branch operations and makes adjustments where needed to increase the overall efficiency of the department
• Investigates complaints and incidents, and oversees and appropriate outcome/resolution
• Submits reports on or before deadline dates
• Provides back up support and handles other functional role responsibilities, as required, to assure that operational needs are met
• Executes additional tasks and responsibilities as needed to contribute to the overall success and operational efficiency of the organization

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree