Market Nurse Leader Houston TX Houston, TX

    UnitedHealth Group Inc.
    Houston, TX 77001
    Full-time
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    Job Description

    Our customer service & claims teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service and across our global economy. Join us and find out why this the place to do your life's best work.SM

    Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

    This position will require 50% travel to clinics within the Houston area. The office is located at 1200 Binz Street Houston, Texas.

    The Market Nurse Leader is responsible for planning, organizing, and directing clinic operations management in assigned market to meet clinical operational needs, and ensure compliance with federal and state requirements, Medicare guidelines, URAC / NCQA / AHCA / OSHA / Joint Commission standards; responsible for developing and implementing policy and procedures, integrating clinical practice guidelines into clinic processes, and overseeing nursing practice standards of licensed nursing personnel. Impact of work is most often at the local level and regional level. Focus is on broad organizational / professional issues and strategic outlook. This position will assist in the clinical professional development of the Clinic Operations management team in their market. This position maintains continuous quality improvement efforts and opportunities directed toward achievement of clinical and healthcare outcomes. The success of this position requires the ability to foster communication and teamwork between clinics / physicians, market management team, corporate departments, and senior leadership. This position will coach others in the application of clinical competency, translating complex nuances related to clinical competency into easy to understand terms; participates in senior-level discussions regarding clinical competency; participates in the development of reference and resource materials on clinical competency. Recognized as the SME for clinical competency, both internally and externally. Develops and / or leads development of new applications and approaches for activities related to clinical competency. The Market Nurse Leader will assist senior leadership with long-term planning initiatives assuring activities are appropriately integrated into strategic direction and overall mission and values of the company.

    Primary Responsibilities
    • Drives effective clinical decisions within a business environment
    • Clinical Interface / Liaison (clinical problem solver with providers, interdepartmental teams; resolution of issues concerning members, program definition and clarification)
    • Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)
    • Clinical Training (planning, coordinating, delivering and evaluating clinical training)
    • Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
    • Demonstrates understanding of business implications of clinical decisions (e.g., financial ramifications)
    • Asks critical questions to ensure member / customer centric approach to work
    • Identifies and considers appropriate options to mitigate issues related to quality, patient safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
    • Utilizes evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results
    • Identifies and implements innovative approaches to the practice of nursing, in order to achieve or enhance quality outcomes and financial performance
    • Serves as subject matter expert to support compliance with applicable federal and state practice health and safety standards, with particular focus on clinical standards and occupational health requirements
    • Conducts clinic assessments for compliance with state and federal health care requirements, Medicare guidelines, and URAC / NCQA / AHCA / OSHA / Joint Commission standards
    • Oversees remediation and corrective action plans, resulting from internal assessments, audits, compliance reviews and self-identified issues
    • Provides leadership and mentoring for clinic staff to ensure patient safety and quality care
    • Serves as a clinical resource for QRA performance and PCMH implementation and sustainment
    • Monitors and ensures compliance with Occupational Health Programs (e.g., TB Screening, Hep B Screening, N-95 Fit Testing, etc.)
    • Advises executive leadership on clinic operations related to nursing practice standard of care
    • Ensures clinic staff has demonstrated appropriate clinical competencies to perform clinic tasks
    • Monitors patient satisfaction and implements plans and programs to continually enhance services provided
    • Participates in professional development activities and education programs to keep staff abreast of health care trends and practices
    • Performs all other related duties as assigned
    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:
    • Master's degree in Nursing or health related field (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Master's degree, with a minimum of a Bachelor of Science in Nursing)
    • Active, unrestricted Registered Nurse (RN) license in the applicable state of employment
    • 8+ years of related experience in a hospital or clinical setting, with 3+ years at management level or higher
    • Demonstrate proficiency in assessment, design, development, implementation, data collection / reporting, and evaluation of initiatives and / or programs
    • Experience in providing leadership and direction for long-range strategic planning
    • Able to establish cooperative and collaborative working relationships in the course of performing assigned duties
    • Basic understanding of standards such as NCQA, AHCA, OSHA, Joint Commission, and Medicare in the managed care setting
    • Proven ability to manage and direct various levels of employees
    • Excellent verbal, written communication, presentation and facilitation skills
    • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
    • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
    Preferred Qualifications:
    • Experience working with psychiatric and geriatric patient populations
    • Bilingual (English / Spanish) language proficiency
    • Case Management Certification (CCM)
    Physical & Mental Requirements:
    • Ability to lift up to 10 pounds
    • Ability to use fine motor skills to operate office equipment and / or machinery
    • Ability to receive and comprehend instructions verbally and / or in writing
    • Ability to use logical reasoning for simple and complex problem solving
    Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi - specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

    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: Market Nurse Leader, Nursing, RN, registered nurse, Houston, TX, Texas

    Posting ID: 588102803Posted: 2020-11-19