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Director RN Clinical Operations

Company: Gelsi Ltd
Location: Houston
Posted on: November 22, 2021

Job Description:

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM $7,500 Sign on Bonus for External Candidates There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing--your life's best work.(sm) 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 Risk Adjustment 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 required. (Eight 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
    • Five + years of management experience in a health care environment
    • Five + years of clinical RN experience
    • Three + years of ICD diagnostic coding and supervisory experience
    • CPC certification or ability to obtain one within 9 months from the American Academy of Professional Coders
    • 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
    • Knowledge of ICD 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
    • Must be able to travel as deemed necessary
    • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
    • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained Preferred Qualifications:
      • Master of Science in Nursing, Healthcare Administration or a related field
      • Previous medical coding operations management
      • Certified Professional Coder (CPC) Physical and Mental Requirements:
        • Ability to lift up to 10 pounds
        • Ability to push or pull heavy objects using up to 25 pounds of force
        • Ability to sit for extended periods of time
        • Ability to stand for extended periods of time
        • Ability to use fine motor skills to operate office equipment and / or machinery
        • Ability to properly drive and operate a company vehicle or rented vehicle
        • Ability to receive and comprehend instructions verbally and / or in writing
        • Ability to use logical reasoning for simple and complex problem solving 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 240,000+ 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) **PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Job Keywords:--RN Director Clinical Data Operations, Houston, TX, Texas Our team members help close the gap in health care. Take a closer look and see how Lisa helps members navigate a complex health care system. We're committed to diversity and inclusion in everything we do. It's ultimately what helps us understand a variety of perspectives and provide quality care to our diverse member population. If you're interested in working for an organization that val--- A Nursing career at UnitedHealth Group can be challenging, yet very rewarding at the same time. Our Registered Nurses and Nurse Practitioners are caregivers through and through. At UnitedHealth Group, they work in a fast-paced environment directly wi--- At UnitedHealth Group we utilize many avenues to find the right candidates to fill open positions. One of which, involves asking our current employees to refer the people they know that would be a good fit for the company. Our employees have great in--- UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-800-561-0861 and say "Application Question" to be connected to Recruitment Services. Recruitment Services' hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday. UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc. 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.

Keywords: Gelsi Ltd, Houston , Director RN Clinical Operations, Executive , Houston, Texas

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