Requisition number: 2349041
Job category: Healthcare Delivery
Optum Home & Community Care, part of the Optum 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) team, we work to provide care to patients at home, nursing homes and 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 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.
Required Qualifications:
Certified Nurse Practitioner or Physician Assistant through a national board
For NPs: Graduate of an accredited Master's degree in Nursing (MSN) program or Doctor of Nursing practice (DNP) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP
For PAs: Graduate of an accredited Physician Assistant degree program and currently board certified by the National Commission on Certification of Physician Assistants (NCCPA)
Active and unrestricted license in the state which you reside
Current active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
3+ years of experience as an APC, demonstrating progressive responsibility
Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Ability to lift a 30-pound bag in and out of car and to navigate stairs and a variety of dwelling conditions and configurations
Ability to gain a collaborative practice agreement, if applicable in your state
Preferred Qualifications:
3+ years of previous management experience
2+ years of leadership and management experience in an organization that serves the chronically ill
2+ years of Medicare experience
1+ years of hands-on post grad experience
1+ years of experience as a CSM at Optum
Leadership and management experience in a CCM market as a CSM with success in effective team building and quality improvement
Ability to quickly adapt to change and drive change management within team and market
Possesses a high level of organizational skills, self- motivation, and ability to manage time independently
Proficient computer skills including the ability to document medical information with written and electronic medical records
Proficient in MS Excel
Possess knowledge and understanding of geriatrics clinical management
Ability to develop and maintain positive customer relationships
Ability to work across functions and businesses to achieve business goals
Effective in motivating and mentoring colleagues and peers
Compensation for this specialty generally ranges from $126,000 to $188,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. 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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
