UHG

About UHG

Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Nurse

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

Director, Clinical Data Operations, Registered Nurse, RN - San Antonio, TX

UHG - Gonzales, Texas

Posted: 11/19/2018

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

 

The Clinical Data Operations Director is 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 DM 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

This is an office-based position, Oaks III, 78249 / Office park located at IH 10 East and De Zavala Road.
 
Local and Non-Local travel is required as determined by the business.


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
  • 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
  • CPC certification or ability to obtain one within 9 months from the American Academy of Professional Coders
  • Knowledge of the following required: federal and state laws relating to managed care, basic principles and practices of clinical nursing, referral processes, claims, case management, contracting and physician practices
  • Strong 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
  • Must be able to travel as deemed necessary

Preferred Qualifications:

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

Physical & 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)

 


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 Keywords: CPC, Coding, American Academy of Professional Coders , AAPC, CPC-A, CRC, Clinical Documentation Improvement, Nurse Auditor, Quality, Risk Adjustment, Data Rap, ICD, CPT, Analysis, Clinical Education, CMS-HCC Model, Consultant, Chart and Medical Records Reviewer, Registered Nurse, RN, 78249, San Antonio, TX

Apply Now