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Field Based Clinical Program Consultant

2 months ago

Fair Oaks Ranch, United States Optum Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Clinical Programs 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 Clinical Programs 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.

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.

This position is full time, Monday - Friday. Employees are required to have flexibility to work any shift schedules during our normal business hours of 8:00 am - 5:00 pm OR 9:00 am - 6:00 pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 19500 IH-10 W Bldg 2 San Antonio, TX . 

We offer weeks of paid on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment. 

Primary Responsibilities:

  • Directs the daily operations of Clinical Programs 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.

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's Degree in health or business administration OR 4+ 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 
  • 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
  • Organizational, communication, interpersonal skills and reliable transportation
  • Ability to travel up to 50% of the time (Domestic) within the state of Texas
  • Reside within a commutable distance of San Antonio, TX
  • Ability to work any shift between the hours of 8:00 AM - 5:00 PM OR 9:00 AM - 6:00 pm from Monday - Friday, including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

  • Experience in a community health OR home health setting 
  • Demonstrated decision-making skills and judgment 
  • Bilingual fluency in English and Spanish

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 

  

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, 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. 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 

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