Clinical Operations Manager - Honolulu, HI - RN Leadership Role at Honolulu

Description:

Positions in this function include those responsible for management and administration of multiple Medical & Clinical Operations Functions (administrative support and UM Nurse Team oversight), or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.

Responsibilities:
Manage and is accountable for Administrative and Clinical Supervisors and indirectly UM Nurses
Provide oversight and review of coordination of care
Develop/oversee/deliver operational or technical training
Develop policies, procedures, and guidelines for clinical operations
Review/approve policy and process changes
Evaluate regulatory changes and determine steps needed to implement in programs
Identify and implement business development opportunities to support growth of medical and clinical operations programs
Oversee/navigate technology and software applications utilized in the delivery of clinical operations
Oversee management/service delivery systems utilized in member care
Intervene in resolution of member or employee complaints or issues as necessary
Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
Measure employee/provider performance against internal procedures and protocols
Ensure team members address gaps in performance against internal procedures and protocols
Develop and communicate performance metrics and expectations
Direct data collection and measurement of outcomes (e.g., customer surveys)
Apply metrics to evaluate services, employee performance, and program outcomes
Read and interpret reports (e.g., performance, service)
Identify causes of performance deficiencies and determine appropriate follow up actions
Drive implementation of best practices and standards
Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
Read financial reports, Identify reasons for financial performance gaps, and Identify opportunities for improved financial performance and enhanced return on investment
Collect and review data to evaluate financial outcomes of programs and services
Conduct cost/benefit analysis on programs to drive efficiencies
Conduct competitive analysis and identify opportunities to enhance financial viability
Propose and obtain approval for capital expenditures for medical and clinical operations

Keywords: Registered Nurse, RN, Supervisor, Manager, Case Manager, Utilization Review, Utilization Management, Case Management, Bachelors Degree, BSN

Qualifications:

Required:

Current and unrestricted Hawaii RN licensure with a Bachelors degree in Nursing (or equivalent experience)
A minimum of 2 years ofexperience with Medicaid/Medicare populations, including LTC and TANF/CHIP
A minimum of 2 yearsof clinical experience applicable to the Medicaid managed care population
At least 1 year ofexperience in Utilization Management (acute and/or HCBS)
A minimum of 2 years ofexperience in a leadership role
Proficient in the use of software applications including, but not limited to MS Office Suite (Outlook, PowerPoint, Excel, Word, Project)
Preferred Assets:

MSN
Certified Case Manager
Experience working in a call center environment
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If youre ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Country: USA, State: Hawaii, City: Honolulu, Company: UnitedHealth Group.