RN Enterprise Clinical Consultant Texas - UnitedHealth Group
San Antonio, TX
About the Job
WellMed, part of the Optum family of businesses, is seeking a Enterprise Clinical Consultant to join our team in Texas. 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 Enterprise Clinical Consultant is responsible for the management and supervision of all Homecare Dimensions Clinical Programs. They will implement and maintain performance improvement activities and maintains regulatory standards for the clinical programs across the branches. This Manager 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 Enterprise Clinical Consultant 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.
Primary 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
In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
+ 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
+ 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
Preferred Qualifications:
+ Experience in a community health or home health setting
+ Demonstrated decision-making skills and strong judgment
+ Bilingual speaking (English/Spanish)
Physical and Mental Requirements:
+ Ability to lift up to fifty (50) pounds (must be able to lift and transfer patients from one location to another, if necessary
+ Ability to push/pull heavy objects using up to fifty (50) pounds of force
+ Ability to sit for extended periods of time
+ Ability to stand for extended period of time
+ Ability to use fine motor skills to operate office equipment and/or machinery
+ Ability to properly drive and operate a personal/company vehicle
+ Ability to receive and comprehend instructions verbally and/or in writing
+ Ability to use logical reasoning for simple and complex situations
_Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._
_OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
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 Enterprise Clinical Consultant is responsible for the management and supervision of all Homecare Dimensions Clinical Programs. They will implement and maintain performance improvement activities and maintains regulatory standards for the clinical programs across the branches. This Manager 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 Enterprise Clinical Consultant 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.
Primary 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
In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
+ 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
+ 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
Preferred Qualifications:
+ Experience in a community health or home health setting
+ Demonstrated decision-making skills and strong judgment
+ Bilingual speaking (English/Spanish)
Physical and Mental Requirements:
+ Ability to lift up to fifty (50) pounds (must be able to lift and transfer patients from one location to another, if necessary
+ Ability to push/pull heavy objects using up to fifty (50) pounds of force
+ Ability to sit for extended periods of time
+ Ability to stand for extended period of time
+ Ability to use fine motor skills to operate office equipment and/or machinery
+ Ability to properly drive and operate a personal/company vehicle
+ Ability to receive and comprehend instructions verbally and/or in writing
+ Ability to use logical reasoning for simple and complex situations
_Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._
_OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
Source : UnitedHealth Group
