Director of Clinical Operations, Dual Special Needs Plan (DSNP) - Missouri

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)The Optum Dual Special Needs Plan (DSNP) at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member’s Primary Care Provider and other providers, and other professionals. Optum providers serve patients’ in their own homes through annual comprehensive assessments, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management. The program’s interdisciplinary care team approach provides needed care in person and through telephonic interventions in collaboration with the members Primary Care Provider and other members of the interdisciplinary care team.The overall goals of the DSNP at Home Program are multi-faceted and include:Improved cost savings through reduced:Medical expenseAcute admissionsAcute ReadmissionsER VisitsAccurate coding of all acute and chronic diagnoses including a supporting individualized plan of careAppropriate preventative care, closure of appropriate Star gapsTaking a holistic approach to the member, a single point of contact helps to navigate the member’s complex chronic health challenges and/or socioeconomic needs. The navigator draws on the Interdisciplinary Care Team to support the member’s unique needsThe Director of Clinical Operations will work closely with the product team to develop and launch the clinical model for the Duals membership, including the development of workflows, processes, and clinical tools and reporting. The role will also help build, support, train and mentor the clinical team necessary to support the model. Direct management responsibilities may also be part of this role.Primary Responsibilities:Strategize, develop, and direct operations of the DSNP community program, in collaboration with the clinical and product teams, to ensure provision of high quality, cost-effective medical services are provided for this membershipMarket clinical staff performance including recruitment, retention and development of clinical staffPut forth recommendations on innovations and process improvements as appropriateTrack/monitor trends, gaps, and regularly analyze data related to clinical delivery model occasionally presenting info to internal or external stakeholdersLead, supervise, and develop members of the DSNP clinical team (2 directs, 30 indirect)Drive clinical success around the above program metrics/targetsCollaborate with national DSNP clinical team on clinical initiatives and model developmentEnsure compliance with State and Federal regulations, as well as company policies and proceduresEnsure compliance of the model with the CMS model of care requirements for Special Needs PlansEnsure high quality focus embedded into clinical model for DSNP includes Stars and accurate coding and documentationDevelopment of clinical staffing models based on enhanced and/or newly developed clinical model(s)Strategize and evaluate methodologies for program adaptation and integration within partnering organizations- support growth with internal and external partners25% travel in market for program assessment, evaluation, education, promoting initiativesYou’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. Required Qualifications:RN, NP or PA with an active, unrestricted license5+ years of clinical experience5+ years of total experience working in Duals (DSNP) and/or Medicaid environment3+ years leadership experience2+ years of experience analyzing data, gaps in care related to clinical delivery model2+ years hands-on experience with HEDIS, Stars, quality initiativesExperience developing and implementing policies, proceduresAbility to travel 25% regularly within market, also occasional national as needed for leadership meetingsPreferred Qualifications:4-year degree, advanced degreeExperience successfully driving to metricsProven track record of strong performance management and developing teamsAbility to manage multiple complex, concurrent projectsExcellent written and verbal communication and relationship building skillsPlanning and organizational skills to demonstrate leadership and initiativeProficient with Microsoft Word, Excel, Outlook, PowerPointAbility to work independently as well as a member of a teamCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)For more information on our Internal Job Posting Policy, click here.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: Nurse Practitioner, Geriatric Nurse Practitioner, NP, Home Care, Director, RN, Kansas City, Saint Louis, Columbia, Springfield, MO, MissouriBrand: ECS - Care ServicesJob ID: 939591Employment Type: Full-timeJob Area: Clinical