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)
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.
The Market Clinical Support role is responsible for assisting the Market Nurse Leader with assessing and training clinic operations staff in assigned market to meet clinical operational needs, and ensure compliance with federal and state requirements, Medicare guidelines, URAC/NCQA/AHCA/OSHA/Joint Commission standards; responsible for reinforcing policy and procedures and integrating clinical practice guidelines into clinic processes. Impact of work is most often at the local level and market level. Focus is on clinic issues and staff training/competency for Joint Commission and PCMH readiness. This position will assist in the clinical professional development of the Clinic Operations teams in their market. This position maintains continuous quality improvement efforts and opportunities directed toward achievement of clinical and healthcare outcomes. The success of this position requires the ability to foster communication and teamwork between clinics/physicians, market management team, and corporate departments. This position will coach others in the application of clinical competency, translating complex nuances related to clinical competency into easy to understand terms; participates in market-level discussions regarding clinical competency; participates in the delivery of reference and resource materials on clinical competency. Recognized as the SME for clinical competency, both internally and externally. Leads education of new applications and approaches for activities related to clinical competency. The Market Clinical Support role will assist the market leadership with long-term planning initiatives assuring activities are appropriately integrated into the market annual plan.
- Drives effective clinical decisions within a business environment
- Clinical Interface/Liaison (clinical problem solver with providers, interdepartmental teams; resolution of issues concerning members, program definition and clarification)
- Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform medical record/clinical audits)
- Clinical Training (planning, coordinating, delivering and evaluating clinical training);
- Demonstrates understanding of business implications of clinical decisions (e.g., financial ramifications).
- Asks critical questions to ensure member/customer centric approach to work.
- Identifies and considers appropriate options to mitigate issues related to quality, patient safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
- Utilizes evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to assist in improving clinical outcomes and achieve business results
- Reinforces innovative approaches to the practice of nursing, in order to achieve or enhance quality outcomes and financial performance
- Serves as subject matter expert to support compliance with applicable federal and state practice health and safety standards, with particular focus on clinical standards and occupational health requirements
- Assists in remediation and corrective action plans, resulting from internal assessments, audits, compliance reviews and self-identified issues
- Provides leadership and mentoring for clinic staff to ensure patient safety and quality care
- Serves as a clinical resource for QRA performance and PCMH implementation and sustainment
- Monitors and ensures compliance with Occupational Health Programs (e.g., TB Screening, Hep B Screening, N-95 Fit Testing, etc.)
- Monitors laboratory compliance with CLIA regulations
- Ensures clinic staff has demonstrated appropriate clinical competencies to perform clinic tasks
- Monitors patient satisfaction and implements plans and programs to continually enhance services provided
- Monitors compliance drills in MedGate for timely completion
- Participates in professional development activities and education programs to keep staff abreast of health care trends and practices
- Performs all other related duties as assigned
This position requires 75% traveling around the San Antonio, TX and surroundings counties, but must be available to travel to other locations if needed.
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.
- Degree in Nursing or health related field (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a degree)
- Active, unrestricted RN license in the applicable state of employment
- Five or more years of related experience in clinical or hospital setting, with two or more years at management level or higher
- Demonstrate proficiency in implementation, data collection/reporting, and evaluation of initiatives and/or programs
- Experience in providing leadership and direction for long-range strategic planning
- Able to establish cooperative and collaborative working relationships in the course of performing assigned duties
- Basic understanding of standards such as NCQA, AHCA, OSHA, Joint Commission, and Medicare in the managed care setting
- Proven ability to manage and direct various levels of employees
- Excellent verbal, written communication, presentation and facilitation skills
- 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
- You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 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 380,000+ 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)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are 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 and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: WellMed, Healthcare, Bilingual, Manager, Registered Nurse, RN, Market Operations, planning, implementation, CMS, Managed Care, NCQA, AHCA, OSHA, Joint Commission, San Antonio, New Braunfels, Seguin, Boerne, Floresville, Texas, TX