Director of Clinical Services Outpatient Operation-Monarch Health - Full-time / Part-time

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)

SUMMARY: The Director of Clinical Services Operations provides operational direction for the functional performance of the Utilization and Care Management Teams. Reporting to the Vice President of Clinical Services, the Director works collaboratively with the Chief Medical Officer and the departmental Medical Directors. The Director is responsible for the achievement of both the department's and the organization's goals and objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. In conjunction with clinical leadership and at the direction of the Vice President, Clinical Services, the Director participates in the establishment of annual goals and objectives for the department.
2. Assumes an active role in the annual development and evaluation of the ambulatory Utilization Management and Case Management Programs, Work plans and Evaluations, working collaboratively with other management staff, including defining outcome measures, meeting regulatory compliances and tracking and trending of key performance metrics.
3. Leads the teams to ensure operational performance and accountability so that functional areas meet productivity goals and objectives of the department and to promote a work climate that promotes high performing teams.
4. Holds responsibility for oversight of the ambulatory Utilization and Case Management for Senior, Commercial, Government Program lines of business.
5. Provides productivity metrics and dashboard reports monthly.
6. Ensures monitoring mechanisms are in place for auto-authorized services and new initiatives.
7. Works closely and collaboratively with department functional leaders, namely, the leaders of Inpatient Care Management, Post-Acute Services, Quality / Credentialing and Strategic Clinical Projects.
8. Maintains direct involvement with interdepartmental and cross department management for operational effectiveness.
9. Identifies and guides implementation of process improvements through root cause analysis and other key learnings to address opportunities for efficiency and performance gains.
10. Sets Teams' direction, resolves problems, and provides guidance and coaching.
11. Works collaboratively and in partnership with all levels and departments within Monarch HealthCare to achieve organizational goals and is an active member of assigned committees.
12. Communicates the vision, mission, and Company values and acts as a role model who strives to achieve the mission through team leadership, commitment, and high performance.
13. Regular and consistent attendance.
14. All other duties commensurate with the position

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE: Current, valid, and unrestricted RN license in the State of California; Certified Case Manager designation (CCM) and a BS degree in Nursing or Healthcare Administration preferred; 5 years related experience in a managed care setting with a focus on Utilization and Care Management including referrals management, under/over utilization, home service programs, complex care management and coordination of care for senior and commercial memberships. Experienced with the delegated model; 3 to 4 years previous experience in a management role is required.

MANAGEMENT RESPONSIBILITIES: Manages exempt and non-exempt employees. Responsible for the overall direction, coordination and evaluation of these employees. Able to carry out management responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees, effective team building; addressing complaints and resolving problems. Able to understand budgetary concepts and ensure department compliance with set budget.

LANGUAGE SKILLS: Ability to read and analyze, and interpret common scientific and technical journals, financial reports and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies or members of the business community. Ability to write speeches and articles from publications that conform to prescribed style and format. Ability to effectively present information to top management, public groups and/or boards of directors.


MATHEMATICAL SKILLS: Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.

OTHER SKILLS and ABILITIES: Excellent verbal and written communication skills. Self-motivated with effective critical thinking skills. Ability to work collaboratively as part of the clinical team. Thorough knowledge of managed care, third party payers, regulatory and accreditation requirements, and government entitlement programs. Excellent telephonic etiquette. Ability to multi-task and set priorities. Ability to work independently. Ability to use all software programs effectively, including MS Office products. Current and valid California Driver's License and automobile insurance.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.



UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.