Clinical Services Manager

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.   

As a team member of our Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. 

We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. 

We're fast becoming the nation's largest employer of Nurse Practitioners; offering a superior professional environment and incredible opportunities to make a difference in the lives of patients. This growth is not only a testament to our model's success but the efforts, care, and commitment of our Nurse Practitioners.

The Sr. CSM role will be instituted according to Optum CCM Model office guidelines. The Sr. CSM in collaboration with market DCO provides leadership and is accountable for the performance of a team of CSM’s as well as a team of Advanced Practice Clinicians (APC’s). In collaboration with the DCO, the Senior CSM will strategize, develop, and direct operations of the clinical department to ensure the provision of high quality and cost-effective medical services are delivered to membership.

The Sr. CSM will:

• Assist in the development of functional market level strategies, plans, and organizational priorities
  
• Identify and resolve technical, operational and organizational challenges outside and within clinical team
  
• develops internal and external strategic relationships, which support program expansion and continuing success
  
• Directly manage clinical staff to ensure business goals/metrics are achieved

Primary Responsibilities:

• Communication and Relationships:
  
  • Leadership Adeptness: Staff Performance, Retention and Development
    
    • Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance, and maximizes staff retention while meeting budget requirements
      
    • Directly lead, supervise, and develop a team of CSM’s as well as team of APC’s
      
    • Maintain overall accountability for clinical team development and performance
      
    • Direct the orientation, training and ongoing education and skill development of the clinical team
      
    • Conduct regular agenda driven meetings with staff to address issues, concerns, and to communicate corporate and site-specific philosophy
      
    • Promotes United culture to ensure succession planning
      
• Business Skills/Healthcare Environment:
  
  • Revenue Accuracy and Medical Management
    
    • Lead the medical expense data analyses
      
    • Determine required improvement efforts for the site, based on outcomes relative to targets and budgeted matrices in collaboration with DCO and Medical Director
      
    • Work in collaboration with DCO to strategize and implement the clinical model 
      
    • Focus on quality improvement and clinically appropriate utilization, while incorporating the skills of provider partners
      
    • Oversee the integrity of the patient-data base system to ensure consistency in the data entry and integrity
      
• Internal and External Strategic Partnerships:
  
  • In collaboration and under the direction of the DCO Implement a program to address the needs of the marketplace-area
    
  • Assist DCO to strategize and evaluate methodologies for program adaptation and integration within partnering organizations
    
  • Conduct regular agenda-driven meetings with selected partners to promote program visibility, and to support a dynamic, results-oriented relationship with selected organizations, contracted facilities, or associated consortium or corporation 
    
  • In collaboration with the DCO and Medical Director strategize with the senior staff regarding:
    
    • Program expansion
      
    • Business development
      
    • New models
      
• Clinical Adeptness:
  
  • Program Quality:
    
    • In collaboration with DCO develops well-designed processes, which will be evident in efficient daily workflows that support the achievement of business goals and improve quality of care, work efficiency, and job satisfaction of the clinical team  
      
    • Assist the DCO in directing the integration of the local quality assurance committee activities 
      
    • Ensure compliance with State and Federal regulations, company policies, and procedures  
      
    • Identify any quality issues and implement quality initiatives for improvement  
      
      • Use reports and other available materials to analyze performance & gaps (know your numbers)   
        
      • Develop & support implementation of corporate & local processes to support QI and to achieve business goals 
        
      • Identify system level opportunities to support QI  
        
      • Provide clinical support and education 
        
      • Hold team responsible for progress in prioritized areas 
        
      • Share best practices across the organization through participation on workgroups 
        
• Professionalism:
  
  • Personal and Professional Accountability:
    
    • Create an environment that facilitates the team to initiate actions that produce positive results 
      
    • Ability to hold self and others accountable for actions and results 
      
    • Answers for one’s own behavior and actions 
      
  • Career Planning:
    
    • Develops own career path 
      
    • Coach others in the development of their career planning 
      
    • Create an environment in which professional and personal growth are an expectation 
      
  • Ethics:
    
    • Integrate high ethical standards and UHG core values into everyday work activities 

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.