Clinical Services Consultant

WellMed, part of the Optum family of businesses, is seeking a Enterprise Clinical Consultant to join our team in Texas. Optum is a clinician‑led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. Role Overview The Enterprise Clinical Consultant is responsible for the management and supervision of all Homecare Dimensions Clinical Programs. They will implement and maintain performance improvement activities and maintain regulatory standards for the clinical programs across the branches. This Manager indirectly supervises all members of the branch staff and performs all functions in a professional and ethical manner and collaborates with other members of the health care team to ensure quality patient care. The Enterprise Clinical Consultant will assure consistent, appropriate, and cost effective care by actively managing patient / client needs, payer's expectations, company policy compliance, and agency financial objectives. They will maintain accountability for achieving financial targets / profitability for the operation by empowering and challenging people, recruiting and training the best people, delivering quality in everything they do, providing the right incentives, providing the resources people need, and creating an environment that enables people to be successful. Primary Responsibilities Directs the daily operations of Clinical Programs/ Operations to ensure the provision of safe, quality, cost‑effective care to patients that contributes to the financial success of the branch Regularly evaluates the services and care provided by the branch to ensure compliance with regulatory requirements, company policies and procedures and sound business practices Directs the recruitment, hiring, and development of sufficient clinical and non‑clinical staff to ensure the delivery of safe and consistent quality care to all patient/clients 24/ 7 Assures that clinical caregivers have demonstrated the ability to perform accurate and complete assessments, communicate with physicians, plan for service delivery, plan for discharge, and make excellent professional decisions Directs or delegates the assignment of staff, monitoring of daily and weekly schedules, and the matching of caregiver qualifications to patient/client needs Manage quality through patient/client care appraisals and employee supervision Directs and participates in care coordination activities that effectively coordinate communication regarding patient/client problems, needs, psychosocial and spiritual concerns, and implementation of an individualized, interrelated plan of care Manages documentation to ensure that the patient/client's clinical record meets legal and regulatory requirements, facilitates care, enhances the continuity of care, helps coordinate treatment and evaluation of the patient/client, and establishes medical necessity so payers will reimburse for the services that are provided Develops and maintains a working knowledge of all services and resources available within the company and the community. Directs staff to meet patient/client needs through the identification and use of all available resources Responsible for interfacing with intake to assure that patient/client's are not admitted for clinical service (case accepted) until they have received an assessment visit and a determination has been made that they are appropriate for home care Responsible for annual evaluations of staff according to company policy and procedures and federal/state regulations Directs ongoing skill evaluations to assure that the staff's abilities are consistent with the needs of individual patient/clients and the marketplace Supervises clinical and operational processes by managing staff and ensuring flow of information and documentation from inquiry through discharge of all patient/clients Provides support and documentation needed to facilitate reimbursement Assists with the development of an annual market assessment, budget, and business plan and monitors expenditures and adherence to company policies through the implementation of controls Assists the Vice President with assessing business opportunities and provides information on costs that can be used in determining the feasibility of pursuing local managed care opportunities. When directed, gathers information about marketplace pay and bill rates Schedules staff meetings to communicate with employees, caregivers when appropriate, regarding the needs and concerns of patient/clients and their families, referral sources, clinical updates, policy and procedure changes, and payer sources and the potential for business that these customers represent Discusses operational issues to identify issues that may compromise optimal service to customers Employs marketing and promotional efforts within the community to support the achievement of new and existing programs Implements and maintains Quality Assurance Performance Improvement for the branch by participating in Quality Assessment and Improvement and CHAPs activities and assures participation of all appropriate staff Provides information that enables the collection and root‑cause analysis of data to identify opportunities for improvement, develops/oversees the development and implementation of action plans that result in continuous quality improvement Oversees branch operations and makes adjustments where needed to increase the overall efficiency of the department Investigates complaints and incidents, and oversees and appropriate outcome/ resolution Submits reports on or before deadline dates Provides back up support and handles other functional role responsibilities, as required, to assure that operational needs are met Required Qualifications Bachelor degree in health or business administration (four additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Bachelor's Degree) Registered Nurse with 6+ years of experience in a clinical leadership / management role Recent experience in acute care or home care (within last 2 years) Working knowledge of governmental home health agency regulations, Medicare (Medicaid, as required), regulations and company policies and procedures Solid organizational, communication, interpersonal skills and reliable transportation This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease Preferred Qualifications Experience in a community health or home health setting Demonstrated decision‑making skills and strong judgment Bilingual speaking (English/Spanish) Physical and Mental Requirements Ability to lift up to fifty (50) pounds (must be able to lift and transfer patients from one location to another, if necessary) Ability to push/pull heavy objects using up to fifty (50) pounds of force Ability to sit for extended periods of time Ability to stand for extended period of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to properly drive and operate a personal/company vehicle Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex situations Pay and Benefits Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far‑reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full‑time employment. We comply with all minimum wage laws as applicable. Equal Opportunity Employment OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr