Regional HIM Manager - OptumInsight

UnitedHealth Group•Bakersfield, CA

5d•$72,800 - $130,000•Onsite

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. Positions in this family include those responsible for functions in areas such as health services, clinical services and delivery of clinical care. Positions in this function include those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family. Manages and is accountable for professional employees and/or supervisors. Impact of work is most often at the local level. Sets team direction, resolves problems and provides guidance to members of own team. May oversee work activities of other supervisors. Adapts departmental plans and priorities to address business and operational challenges. Influences or provides input to forecasting and planning activities. Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external).

Requirements

3+ years of HIM management experience
2+ years of Health care experience
Driver’s License and access to a reliable transportation

Nice To Haves

Epic HIM Certification
RHIT or RHIA credential

Responsibilities

Review and Implement Medical and Clinical Protocols for Staff Oversight and Development
Leverage clinical acumen to provide guidance to staff (e.g., disease state, health conditions)
Assist staff in navigating the medical management system (e.g., find resources, answers questions)
Provide oversight and review of coordination of care (e.g., chronic condition management, utilization management, case management)
Ensure employees are current with clinical licensure and certifications
Develop/oversee/deliver operational or technical training
Plan/Implement/Manage Medical and Clinical Ops Programs
Develop policies, procedures, and guidelines for medical and clinical operations programs
Review/approve policy and process changes
Evaluate regulatory changes and determine steps needed to implement in programs
Develop medical and clinical operations program goals
Identify and implement business development opportunities to support growth of medical and clinical operations programs
Oversee/navigate technology and software applications utilized in the delivery of medical and clinical operations programs
Oversee management/service delivery systems utilized in member care
Intervene in resolution of member or employee complaints or issues as necessary
Create and implement a business continuity plan to minimize interruptions to the business
Ensure Compliance of Medical and Clinical Ops Programs and Services
Interpret compliance/clinical/medical reports
Evaluate compliance with Federal, State, and Local regulatory and organizational guidelines
Evaluate programs and services against accreditation standards
Evaluate programs and services against contractual requirements
Oversee ongoing monitoring and internal auditing against relevant guidelines and standards
Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
Measure employee/provider performance against internal procedures and protocols
Ensure team members address gaps in performance against internal procedures and protocols
Monitor/Evaluate Overall Medical and Clinical Ops Service, Employee Performance, and P
Develop and communicate performance metrics and expectations
Direct data collection and measurement of outcomes (e.g., customer surveys)
Apply metrics to evaluate services, employee performance, and program outcomes
Read and interpret reports (e.g., performance, service)
Identify causes of performance deficiencies and determine appropriate follow up actions
Drive implementation of best practices and standards
Plan and Manage Medical and Clinical Operations to Ensure Financial Viability
Develop operational budgets for medical and clinical operations
Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
Read financial reports, identify reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
Collect and review data to evaluate financial outcomes of programs and services
Conduct cost/benefit analysis on programs to drive efficiencies
Conduct competitive analysis and identify opportunities to enhance financial viability
Propose and obtain approval for capital expenditures for medical and clinical operations