RN Clinical Quality/Safety Consultant South Fort Worth

Company: UnitedHealth Group
Location: Joshua
Posted on: November 20, 2023

Job Description:

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.------ -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
  • May serve as immediate supervisor of 2 or more Regional Nurse Leaders
    • Supervises assigned personnel to ensure quality patient care, including forms and procedures as required
    • Evaluates performance and recommends merit increases, promotions, and disciplinary actions, assists in interviews, trains, and orients staff
    • 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 assignedYou'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.Years of post-high school education can be substituted/is equivalent to years of experience.Required Qualifications:
      • Active, unrestricted Registered Nurse (RN) license in the applicable state of employment
      • 8+ additional years of comparable work experience beyond the required years of experience
      • 8+ years of related experience in a hospital or clinical setting, with 3+ years at management level or higher
      • Experience in providing leadership and direction for long-range strategic planning
      • Basic understanding of standards such as NCQA, AHCA, OSHA, Joint Commission, and Medicare in the managed care setting
      • Demonstrate proficiency in assessment, design, development, implementation, data collection/reporting, and evaluation of initiatives and/or programs
      • Proven ability to establish cooperative and collaborative working relationships in the course of performing assigned duties
      • Proven ability to manage and direct various levels of employees
      • Proven excellent verbal, written communication, presentation and facilitation skills
      • This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease -Physical & Mental Requirements:
        • Ability to push or pull heavy objects using up to - - - - - -pounds of force
        • Ability to stand for extended periods of time
        • Ability to properly drive and operate a company vehicle At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.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.

Keywords: UnitedHealth Group, Dallas , RN Clinical Quality/Safety Consultant South Fort Worth, Healthcare , Joshua, Texas