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in Irvine, CA

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Hours Full-time, Part-time
Location Irvine, CA
Irvine, California

About this job

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 Vice President, Clinical Services supports the Chief Medical Officer (CMO) by overseeing the direction and management of the Clinical Services Department, providing overall leadership in process development and administration of all clinical operations departmental functions.

 

The Vice President, Clinical Services works in collaboration with the CMO, Medical Directors, and Clinical Services Directors to ensure the successful achievement of Monarch HealthCare's vision by participating in the development and implementation of clinical strategic initiatives to achieve the department's goals and objectives in compliance with established medical policies and procedures and health plan delegation agreements.

 

This position is responsible for daily medical management operations and monitors the Clinical Services Department's functions in attaining defined goals and objectives that are consistent with the strategic, operational, and budgetary goals approved by the Board of Directors. This includes all staffing and activities related to Referral Management, Outpatient Case Management, Disease Management, Inpatient Case Management and Quality Management / Credentialing.

 

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

 

1. Assumes a leadership role in the direction, monitoring and support of the

Clinical Services staff.

 

2. Directs others to resolve business problems that affect multiple functions or disciplines.

 

3. Identifies opportunities for improvement and provides additional orientation, training and skill development on an ongoing basis.

 

3. Ensures that all department functions are staffed appropriately and that all departmental processes are completed in a timely and accurate manner on a regular basis.

 

4. Participates in the development of health plan/provider contracts and

service standards.

 

5. Maintains regularly scheduled meetings with direct reports including 1:1's scheduled and individual meetings but always maintains an “open-door “policy to staff.

 

6. In collaboration with the Directors, develops, implements and reviews the Quality Improvement and Utilization Management plans and programs annually, and revises as needed, to assure that all applicable governmental and accrediting agencies regulations are met or exceeded.

 

7. Participates in the Clinical Services Medical Management Team and collaborates with the CMO, Medical Directors and Clinical Directors in all strategic planning, including establishing annual departmental goals and objectives by function, product development, process improvement initiatives and critical decision making.

 

8. Under the direction of the CMO and in collaboration with the Medical Directors and Clinical Services Directors, develops and coordinates the implementation of medical management processes, policies and procedures to assure that medically necessary services are delivered in an optimally cost and quality efficient manner.

 

9. In partnership with Medical Directors and Clinical Services Directors, identifies areas of over or under clinical utilization, often through collaboration with finance and decision support departments. In conjunction with the CMO and the Clinical Services Medical Management Team, develops and implements corrective action plans resulting in required process changes and outcomes when aberrant trends are identified.

 

10. Promotes a culture of open, clear communication and collaboration inter- departmentally, intra-departmentally, and with external customers and organizations. Fosters and promotes the company's values, such as

Integrity, Compassion, Relationship, Innovation and Performance. Drives

operational excellence, employee engagement and career development.

 

11. Under the direction of the CMO and in cooperation with the Finance Department, Medical Directors and Clinical Directors, develops, monitors, and implements the clinical services budgets and Provider contract renewals. Justifies and approves expenditures per company policy and documents budget variances as required.

 

12. Leads and supports the Clinical Services Directors as needed in

establishing department philosophy and objectives related to staffing and performance standards and policies and procedures, to ensure compliance with State and Federal regulatory requirements, legislative mandates, health plan delegation requirements, and accreditation standards.

 

 

13. Promotes effective working relationships with health plan partners through active engagement and participation with the health plans. Works in conjunction with the CMO to identify and develop appropriate Joint Operations Committee (JOC) agenda items.

 

14. Analyzes work processes and systems and identifies improvement opportunities. Develops appropriate business metrics to optimize decisions, clinical outcomes and productivity. Works with CMO, Medical Directors and Clinical Directors to implement process and system improvements in order to achieve departmental efficiencies and resolve operational issues. Additionally, works collaboratively with key stakeholders, both inside and outside of the Clinical Services Department, to identify and make recommendations for improvements to processes and systems.

 

15. In conjunction with the CMO, and in collaboration with the Medical Directors and Clinical Directors, develops and leads new program development. May participate in or lead project task forces or committees to accomplish strategic goals. Gathers data and determines resource needs.

 

16. Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and license requirements (if applicable), and current MHC policies and procedures.

 

17. In conjunction with the Clinical Services Medical Management Team, reviews and approves pertinent marketing materials and member communications developed by the marketing and provider network departments.

 

18. In partnership with the Clinical Directors, develops and coordinates recognition programs for the clinical staff, such as Nurse's Week.

 

19. Performs other related duties as required.

 

20. Regular and consistent attendance and at no time will exceed paid time off without the explicit authorization of the CMO.

 

21. Serves as liaison and channel of communication between the CMO and committees, external customers and organizations, and the medical and administrative staff.

Requirements

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: Bachelor's degree in Nursing or a health care related field, California R.N. License required; Master's degree in Business Administration or a health care related field preferred. Minimum ten years of medical management experience with IPAs, medical groups or HMOs. Prior medical management experience of multiple departments or functional areas within a managed care setting. Familiarity with Federal and State governmental health care regulations and accrediting agency requirements.

 

LANGUAGE SKILLS: Ability to read and analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from those within the organization as well as to groups outside of the company.

 

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

 

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to analyze data and formulate a practical business application. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Problem analysis and resolution at both a strategic and functional level.

 

OTHER SKILLS and ABILITIES: Thorough knowledge of HMO, IPA and managed care business concepts and principles. Excellent organizational and communication skills. Adept at organizing and running meetings. Proficient in the utilization of software programs such as Excel and Word. Leadership: a demonstrated ability to lead people and get results through others; drive employee engagement; foster teamwork and collaboration; learn and develop self; influence and negotiate, listen actively, demonstrate emotional resilience, and implement innovative solutions. Management: the ability to organize and manage multiple priorities.

 

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.

 

While performing the duties of this job, the employee is regularly required to use hands to finger, handle or feel, reach with hands and arms, talk or hear. The employee is frequently required to stand, walk, and sit.

 

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.