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Director Clinical Operations - Senior Community Care - IL at UnitedHealth Group

Director Clinical Operations - Senior Community Care - IL

UnitedHealth Group Charlotte, NC (On Site) 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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)



The market DCO provides leadership and is accountable for the performance of a team of CSMs. In collaboration with the RVP, the DCO will strategize, develop, and direct operations of the of the health services department to ensure that the provision of high quality, cost-effective medical services are delivered to membership.



This position will require that you are in the Chicago, IL area at least 50% of the time. 



Primary Responsibilities:




  • Development and management of budget related medical care 

  • Works with the site medical expense team to provide direction for actions to control targeted costs for inpatient and outpatient services  

  • Ensure compliance with State and Federal regulations, as well as company policies and procedures  

  • Oversee the integrity of the patient-data base system to ensure consistency in the data entry and integrity  

  • Coordinate plans with the local and national quality committee to comply with CMS regulations and National accreditation agencies  

  • Strategize with the senior staff regarding:

  • Program expansion

  • Business development

  • New models

  • Collaborate cross-functionally to meet site business goals and objectives 

  • Engage and drive all staff in implementing activities to meet business goals 

  • Implement and support new programs and/or new care models 

  • Participate in and lead special project groups that provide skill building opportunities for the participants, and allows others to display leadership capabilities 



Communication and Relationships:




  • Leadership Adeptness: Staff Performance, Retention and Development

  • Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance, and maximizes staff retention while meeting budget requirements 

  • Directly lead, supervise, and develop a team of CSM’s 

  • Maintain overall accountability for clinical team development and performance 

  • Direct the orientation, training and ongoing education and skill development of the health services staff 

  • Conduct regular agenda driven meetings with staff to address issues, concerns, and to communicate corporate and site-specific philosophy 

  • Promotes United culture to ensure succession planning  



Revenue Accuracy and Medical Management:




  • Develop and routinely update comprehensive medical management work plans/programs for the site 

  • Lead the medical expense data analyses  

  • Determine required improvement efforts for the site, based on outcomes relative to targets and budgeted matrices 

  • Strategize and implement the clinical model  Focus on quality, to appropriately reduce medical cost while incorporating the skills of provider partners whenever possible  

  • Focus on quality improvement and clinically appropriate utilization, while incorporating the skills of provider partners 



Program Quality:




  • Coordinate quality program and contractual requirements, maintaining compliance with regulatory and accreditation requirements

  • Direct the development of well-designed processes, which will be evident in efficient daily work flows that support the achievement of business goals  

  • Direct the integration of the local quality assurance committee activities 

  • Identify any quality issues and implements quality initiatives for improvement  

  • Use reports and other available materials to analyze performance & gaps (know your numbers)  

  • Develop & support implementation of corporate & local processes to support Quality Improvement (QI) and to achieve business goals 

  • Identify system level opportunities to support QI  

  • Provide clinical support and education 

  • Hold team responsible for progress in prioritized areas 

  • Share best practices across the organization through participation on workgroups 



Internal and External Strategic Partnerships:




  • Implement a program to address the needs of the marketplace 

  • Strategize and evaluate methodologies for program adaptation and integration within partnering organizations  

  • Conduct regular agenda-driven meetings with selected partners to promote program visibility, and to support a dynamic, results-oriented relationship with selected organizations, contracted facilities, or associated consortium or corporation  



Staff Performance, Retention and Development:




  • Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance, and maximizes staff retention while meeting budget requirements 

  • Directly lead, supervise, and develop the health services leadership team 

  • Maintain overall accountability for clinical team development and performance 



Professionalism:




  • Personal and Professional Accountability:

  • Create an environment that facilitates the team to initiate actions that produce positive results 

  • Ability to hold self and others accountable for actions and results 

  • Answers for one’s own behavior and actions 

  • Career Planning:

  • Develops own career path 

  • Coach others in the development of their career planning 

  • Create an environment in which professional and personal growth are an expectation 

  • Ethics:

  • Integrate high ethical standards and UHG core values into everyday work activities 





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:




  • RN degree certified through a national state board and with active license 

  • Active and unrestricted license in the state which you reside

  • 3+ years of leadership and/or management experience 

  • Experience with Medicare, Medicaid and managed care in a variety of health care settings

  • Leadership and management experience in effective team building and continuous quality improvement programs

  • Solid negotiation skills, budget management experience and regulatory knowledge 

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation



Preferred Qualifications:




  • Master’s degree ideally in nursing, health sciences, social services or business

  • 5+ years of leadership and management experience in an organization that serves the elderly or chronically ill population

  • 3+ years of experience at Optum

  • Leadership and management experience in a CCM market as a CSM or Sr. CSM with success in effective team building and quality improvement

  • Possess knowledge and understanding of geriatrics clinical management

  • Proficient in excel

  • Effective in motivating and mentoring colleagues and peers

  • Proficient computer skills 

  • Possess a high level of organizational skills, self- motivation, and ability to manage time independently

  • Ability to develop and maintain positive customer relationships

  • Ability to quickly adapt to change and drive change management within team and market

  • Ability to work across functions and businesses to achieve business goals





To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment



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.

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