Job Description

RN Director Clinical Data Operations San Antonio Texas Location San Antonio, TX (Dignowity Hill area) :

Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic stat that understands and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

Director, Clinical Data Operations - responsible for planning, organizing and directing the operation and administration of all DataRAP department operations. Coordinates departmental duties with appropriate personnel to meet program needs, ensures compliance with state and federal health plan requirements and (CMS) Medicare guidelines. Develops and implements policies, procedures, and updates and integrate current clinical practice guidelines. The success of this position requires the ability to foster communication and teamwork between physicians, clinic staff, disease management staff, corporate departments, vendors, and senior leadership. The director will provide long-term planning and oversight to maintain operations of the department assuring activities are appropriately integrated into strategic direction, as well as the mission and values of the company. Works cooperatively with the Director of Quality and Training to meet the training needs of entire the network of providers and staff.

Primary Responsibilities:

• Directs and facilitates departmental functions for the health plan, medical group and other related entities
• Communicates and provides the direction to coordinate the work activities of the management team and nursing / clinical staff in the DR department
• Ensures the timely preparation of reports, budgets, and records for dissemination to stakeholders
• Provides and implements strategic goals per market to in a timely manner and communicates to stakeholders
• On an ongoing basis, assess the nurse staffing needs of the department based on the volume of work and the departmental production goals, and make adjustments to maintain quality service
• Administers and supervises recruitment and hiring practices for the department
• Interacts directly with all health plans, medical groups and senior leadership and acts as a resource to all internal and external customers
• Ensures departmental operations, policies and procedures are compliant with health plan standards, accreditation standards and state / federal regulatory agencies.
• Administers and supervises the implementation of all departmental policies and programs
• Provides oversight to managers and promotes personal growth and development for team members
• Works with key members of other WMMI departments to facilitate internal and external processes
• Ensures accuracy, security and confidentiality of all member and personnel records
• Provides excellent customer service, monitors quality service and customer service delivery by nursing staff
• Serves on and chairs corporate committees, task forces, and / or work groups
• Directs and assists the management team when needed in performance appraisals and employee counseling
• Communicates process changes related to training needs of the providers and the employees to the Director of Quality and Training for development
• Performs all other related duties as assigned

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 of Science in Nursing, Healthcare Administration or a related field (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
• Current Registered Nurse (RN) license in applicable state
• CPC certification or ability to obtain one within 9 months from the American Academy of Professional Coders
• 5+ years of management / supervisory experience in a health care environment
• 5+ years of clinical RN experience
• 3+ years of ICD-9 diagnostic coding and supervisory experience
• Knowledge of the following: federal and state laws relating to managed care, basic principles and practices of clinical nursing, referral processes, claims, case management, contracting and physician practices
• Solid knowledge of ICD-9 coding processes with excellent analytical and data mining skills
• Ability to effectively plan programs and evaluate accomplishments, present findings in executive-level reports and presentations and exercise sound problem-solving and decision-making skills
• Ability to effectively manage various levels of staff, projects, planning, and implementation of programs and processes and evaluate outcomes
• Proficiency with Microsoft Office applications and other DataRAP database programs
• Ability to travel as deemed necessary

Preferred Qualifications:

• Master of Science in Nursing, Healthcare Administration or a related field
• Certified Professional Coder (CPC)
• Previous medical coding operations management

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.

Job Tags

Full time, Work experience placement,

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