VP Clinical Services, RN - Monarch HealthCare - Irvine, CA

Opportunities with Monarch HealthCare. Every individual deserves health care that is affordable, accessible and fits his or her unique needs. At Monarch HealthCare, we have built Orange County's largest network of physicians, hospitals and urgent care centers. We believe that offering the most extensive choices and access allows our patients to get the right care at the right time. It's this passion that drives our commitment to excellence in patient care, and makes us a fitting partner for the high performing culture of Optum Local Care Delivery and UnitedHealth Group.

The health care industry is constantly changing. But our solid commitment to provide the best care to our patients will always remain the same. When it comes to finding better ways to care, we will be part of the solution. You can be, too. Together, we will make a difference. It's all part of doing your life's best work.(sm)

The Vice President of 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.

Primary Responsibilities: 

• Assumes a leadership role in the strategic direction, monitoring and support of the Clinical Services Department Staff

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

• 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

• 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

• 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. Justifies and approves expenditures per company policy and documents budget variances as required

• 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

• 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

• 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

• 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

Required Qualifications:

• Current and unrestricted RN license and BSN

• 5 or more years of medical management experience with IPAs, medical groups or HMOs

• Prior management experience over multiple departments or functional areas within a managed care setting

• Proven track record of quality leadership and exceptional teamwork in order to build and foster stellar working relationships in both Clinical and Operational departments

• Familiarity with Federal and State governmental health care regulations and accrediting agency requirements 

Preferred Qualifications:

• Master's degree in Business Administration or a health care related field

• Public presentation skills 

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.

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: Nurse leader, VP, Vice President, BSN, MSN, MHA, managed care, IPA, health plan, HMO, RN, Orange County, Irvine, CA