Clinical Programs Manager
2 months ago
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.
Key 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.
Requirements:
- 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
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