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.
Here's an opportunity that's truly different and immensely rewarding. We're always looking for innovative approaches for delivering best results and improving our scope of care. The Clinical Strategy - Manager leads the clinical staff on all activities related to medical management initiatives including changes in process, staffing, care delivery model and will lead the strategy for business expansions. Additionally, the manager ensures compliance with all state/federal regulations and NCQA/URAC standards as well as collaborate with the Business Partners and directors to establish strategies to enhance overall Scope of work.
- Supports clinical operation leaders across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
- Ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS for each clinical operation
- Performs Clinical Team forums/meetings to support activities and initiatives that enhance engagement, performance, and performance compliance for each clinical team.
- Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
- Find solutions and implement strategies for performance compliance enhancement
- Tracks and trends outcomes for potential improvements for each clinical process. Creates, monitors, evaluates, and disseminates program and productivity reports weekly, monthly, and as needed
- Monitors appropriate utilization of resources, overtime, supplies and mileage as applicable
- Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
- Perform comprehensive evaluations of PR an USA Clinical Nurse Licensure and Credentialing process as well as jurisdiction regulations order to increasing our OGA-PR NCLEX certified clinical staff opportunities
*** ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***
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.
- Bachelor of Science in Nursing (BSN)
- RN - NCLEX Licensure - (Able to endorse to all required states.)
- 3+ years of experience in healthcare operations
- 2+ years of experience in managed care, hospital and/or physician practice setting
- 2+ years of demonstrated supervisory or management experience with responsibility for team performance management
- Experience with MS office including Word, Excel, and Outlook with proficient ability to navigate in a Windows environment
- Data mining, analytical and reporting skills
- In and/or out-of-town local travel as deemed necessary by business need
- Master’s Science in Nursing
- Experience in NCLEX Licensure and Credentialing process
- Multi-site regional operations management responsibility
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
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.