RN Enterprise Clinical Consultant Texas

UnitedHealth Group•New Braunfels, TX

4d•$91,700 - $163,700•Onsite

About The Position

WellMed, part of the Optum family of businesses, is seeking an Enterprise Clinical Consultant to join their team in Texas. Optum is a clinician-led care organization focused on improving how clinicians work and live. As a member of the Optum Care Delivery team, you will contribute to the vision of making healthcare better for everyone. Optum provides the clinical resources, data, and support of a global organization to help patients live healthier lives. The company believes in offering an exceptional career and empowering employees to live their best lives at work and at home. This role offers the fulfillment of advancing community health and the excitement of contributing new practice ideas and initiatives that could improve care for millions of patients nationwide. The company culture emphasizes collaboration, connection, and growth. The Enterprise Clinical Consultant is responsible for managing and supervising all Homecare Dimensions Clinical Programs. This includes implementing and maintaining performance improvement activities and ensuring compliance with regulatory standards for clinical programs across branches. The role indirectly supervises all branch staff, performing duties in a professional and ethical manner and collaborating with the healthcare team to ensure quality patient care. The Enterprise Clinical Consultant will ensure consistent, appropriate, and cost-effective care by actively managing patient/client needs, payer expectations, company policy compliance, and agency financial objectives. They will be accountable for achieving financial targets and profitability by empowering and challenging people, recruiting and training staff, delivering quality, providing incentives, offering necessary resources, and creating a supportive environment for success.

Requirements

Bachelor degree in health or business administration (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 a clinical leadership / management role
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
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

Experience in a community health or home health setting
Demonstrated decision-making skills and strong judgment
Bilingual speaking (English/Spanish)

Responsibilities

Directs the daily operations of Clinical Programs/ Operations 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 branch 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, Manage 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. Directs staff to meet patient/client needs through the identification and use of all available resources
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. When directed, gathers information about marketplace pay and bill rates
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 new and existing programs
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