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Sr. Director Clinical Integrations - WellMed (TX / FL)

UnitedHealth Group


Location:
TX
Date:
01/23/2018
2018-01-232018-02-21
Job Code:
737197
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Job Details

737197 Sr Director Clinical Integrations WellMed TX FL

Sr. Director Clinical Integrations - WellMed (TX / FL) (737197)

Position Description

The Sr. Director, Clinical Integrations oversees strategic initiatives and provides overall facilitation, support and leadership for enterprise - wide, large scale strategic new market initiatives, Macro acquisitions, and facilitates the completion of clinical integration efforts for newly acquired clinics.  This position is responsible for directing and facilitating the project planning, project management, implementation and evaluation of integration efforts as it relates to new market initiatives across multiple states and markets.  

This Sr. Director will be accountable to meet the operational program needs and ensure compliance with state and federal health plan requirements, Medicare guidelines, and URAC / NCQA standards. They will develop and implement policy and procedures, updates and lead integration of current clinical practice guidelines, perform employee counseling, performance appraisals, and oversight of employee training and development. In addition, this Director will be responsible for developing / maintaining effective relationships with Medical Directors, market teams, medical management teams, clinical education / training teams, physician business managers, and contracted providers / staff to assure market expansion and clinic integration activities and to ensure goals are achieved in accord with set timeframes.

This role will maintain oversight of continuous quality improvement opportunities directed toward achievement of clinical and healthcare outcomes for new markets and newly acquired clinics. The Sr. Director, Clinical Integrations will oversee clinical long - term planning priorities and assures that new markets are appropriately integrated into the overall strategic direction, mission and values of the enterprise. 

 

Primary Responsibilities:

  • Directs, participates in the complex Clinic Due diligence and Mock Compliance Audits

  • Manages medical management team (5+ RNs) TX(2) / FL(3)

  • Directs complex due diligence medical record review prior to clinic/practice acquisition

  • Directs the strategic planning and management of the new market integration projects and team to ensure that the goals and objectives are accomplished within the prescribed time frame

  • Directs the project management and process improvement activities to achieve optimal implementation and facilitate achievement of core measures

  • Directs the clinical input, training and impacts to the provider, clinic, and / or market team members providing understanding of Clinical Processes and Compliance

  • Identifies, directs, communicates, and executes continuous quality improvement activities or processes to ensure integrations are seamless and that clinic standards meet all necessary requirements

  • Directs and coordinates the planning, implementation, data collection / reporting, evaluation and control phases of assigned initiatives

  • Directs and provides guidance to new providers and staff through implementation, and execution of orientation, and training to new acquisitions and new markets

  • Provides information to departments as needed and serves as the departmental liaison for all providers, staff, and market team members during initiative phase

  • Providing effective problem solving and relationship building

  • Oversees and directs the development, planning, and execution of continual process improvement efforts, policies and procedures, and regulatory compliance functions related to Market integration activities

  • Provides guidance on company or clinic issues and ensures proper resolution and dissemination of information to parties involved

  • Provides input to Executive Management and Clinic Management as needed in establishing departmental objectives related to staffing plans, financial goals, etc.

  • Oversees and directs the integration work plan

 

Required Qualifications:

  • BS required

  • Active, unrestricted RN license state of TX

  • 8+ years in healthcare;  to include any combination of years of experience within the multiple / various areas and together equal 8 years:

    • Clinical operations / processes

    • Staff training and development

    • Utilization Review, Care & transition management

    • 4+ years of leadership / management experience

  • Advanced knowledge and experience in Healthcare Operations (EMR, Practice Management System, Clinic Operations, Health Care Cost management, systems)

  • Able to resolve issues using sound judgment in the development of strategies
    and contractual relationships

  • Must possess strong analytical / statistical skills used in evaluating healthcare data as used in the development, implementation and monitoring of contractual relationships, utilization review and transition management

  • Strong interpersonal skills with ability to interface effectively externally and
    internally at multiple levels: physicians, office staff and other health plan staff

  • Knowledge of clinical policies and procedures and ability to interpret and

  • Understanding standards such as and CMS, URAC, HEDIS, and NCQA compliance regulations, in managed care settings

  • Proven ability to effectively manage and direct various levels of employees and remote team members

  • Excellent verbal, written, communication, presentation, facilitation skills

  • Ability to travel required up to 80% within TX / FL

 

Preferred Qualifications:

  • Advanced degree

  • Experience with Mergers and Acquisitions

  • Experience providing input into due diligence efforts

  • Managed care and Medicare Advantage experience

 

 

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 320,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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.

 
 

 

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.

 

Job Details

  • Contest Number737197
  • Job TitleSr. Director Clinical Integrations - WellMed (TX / FL)
  • Job FamilyHealthcare Delivery
  • Business SegmentOptumCare

Job Location Information

  • TX
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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