UnitedHealth Group Registered Nurse, RN, Clinical Process Manager, PM, WellMed - San Antonio, TX in Yoakum-Texas, Texas
For those who want to invent the future of health care, here's your opportunity.
We're going beyond basic care to health programs integrated across the entire continuum of care.
Join us and help people live healthier lives while doing your life's best work.(sm) The Clinical Process Manager is responsible for managing and evaluating care coordination processes for an assigned region or assigned team (i.e., medical group, region, and market). The position also collaborate with administrators and physician business partners to update staff on all activities related to care management functions including changes in process, staffing, programs or regulatory compliance functions.
Works on a wide range of activities related to Care Coordination to include planning, analysis and development of action plans between Medical Management teams (Care Coordination, UM, DataRAP, ITC, Clinical Education & Development) and clinics.
Serves as a resource on process improvement concepts, principles and strategies. Primary Responsibilities: Participates in the development, planning, and execution of continual process improvement efforts, policies and procedures, and regulatory compliance functions related to care management activities Develops initiatives for continual process improvement of care coordination programs Develops new policies, procedures and work flows that enhance operating efficiency of the care coordination programs or activities Evaluates the success of process improvement efforts and implements solutions for growth opportunities Collaborates with Director, Clinical Implementation, other managers and/or other departments to drive processes Solves problems by gathering and/or reviewing facts and selecting the best solution from identified alternatives Must apply individual reasoning to the solution of problems, devising or modifying processes and writing procedures as necessary Reviews data, develops recommendations and reviews findings with Director and other managers Maintains current knowledge regarding Care Coordination and Medical Management processes Attends educational offerings to keep abreast of change within the various Care Coordination Functions Participates in committees and interdisciplinary conferences related to care coordination functions as needed Performs the role of Clinical Training and Program Administration Subject Matter Expert (SME) on cross-functional project initiatives Provides support as a SME to clinics to ensure Care Coordination functions are appropriately performed by team members.
Collaborates with the Clinical Education & Development team to ensure adequate training needs are met for the Care Coordination and Medical Management team members.
Performs all other related duties as assigned. Required Qualifications: Bachelor of Science in Nursing (BSN) required (Eight additional years of experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree) Active Registered Nurse (RN) license in the applicable state Three years of healthcare data analysis experience to include experience in a managed care setting, hospital setting and/or physician practice setting Two or more years of management experience in a healthcare environment, including one or more years in Disease Management or Case Management Two to four years of clinical reviewing experience with strong attention to detail and a high level of accuracy One year of related experience working with the chronically ill population Solid data mining, analytical and reporting skills required.
Must be able to review and interpret data to make recommendations Out-of-town travel required as deemed necessary by business need Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public Preferred Qualifications: Masters of Science in Nursing Two or more years’ experience working with the geriatric population 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 90,000+ 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: WellMed, Healthcare, Bilingual, Registered Nurse, RN, Joint Commission, URAC/NCQA regulations, PMP, Clinical Process Manager, DataRAP, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Network Blvd., 78249, TX b94ba283-1c6c-469a-aea1-70db8619bd37
Registered Nurse, RN, Clinical Process Manager, PM, WellMed - San Antonio, TX Texas-San Antonio 719979