For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Manager of Clinical Quality-RN/LVN- Offering a $5000 SIGN-ON Bonus!!Schedule: Monday-Friday 8am-5pm with some flexibility required Primary Responsibilities:Coordinates coverage of local staffing needs, arranging coverage for sick calls and vacation planning and monitors timecard accuracy Provides direct day to day oversight for all assigned staff Delegates tasks to appropriate staff within the QI department Responsible to oversee the completion of the QI quarterly program evaluations, monitoring improvement and compliance Performs direct QI functions for local IPA, as assigned In conjunction with the local Medical Director, Executive Director, and QI Director, implements quality improvement strategies Day to day responsibility for the QI Programs (P4P, 5 STAR, etc.) Communicates changes in policy and procedure to assigned staff Reports performance to targets and works with QI Director to develop intervention strategies Provides lead communication link from denial and appeal unit to the UM department
Required Qualifications:Current and unrestricted RN or LVN license in California 1+ years of experience in lead / supervisory position 1+ years of experience in direct clinical role Knowledge of HMO and MCO operations Experience in the development and implementation of improvement strategies (both clinical and service) Proficient in Microsoft Office products: Word, ExcelPreferred Qualifications:Knowledge of general PMG / IPA operations Previous experience developing departmental infrastructure Knowledge of continuous quality and utilization/medical management techniques and operations Previous external accreditation experience (NCQA, JCAHO) Experience in Denials, Appeals, and Grievance resolutionCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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) North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets. 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: Clinical Quality, HMO, MCO, appeals, grievances, appeals, NCQA, JCAHO, UM, RN, LVN, Lead, Supervisor, Ontario, CA
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.