Regional HIM Manager - OptumInsight Job Bakersfield area,California USA,Management

Job Family Description

Positions in this family include those resposnsible for functions in areas such as health services, clinical services and delivery of clinical care.

Job Function Description

Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.

General Job Profile:

Manages and is accountable for professional employees and/or supervisors
Impact of work is most often at the local level

Job Scope and Guidelines:

Sets team direction, resolves problems and provides guidance to members of own team
May oversee work activities of other supervisors
Adapts departmental plans and priorities to address business and operational challenges
Influences or provides input to forecasting and planning activities
Product, service or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external)

Primary Responsibilities:

and Implement Medical and Clinical Protocols for Staff Oversight and Development
- Leverage clinical acumen to provide guidance to staff (e.g., disease state, health conditions)
- Assist staff in navigating the medical management system (e.g., find resources, answers questions)
- Provide oversight and review of coordination of care (e.g., chronic condition management, utilization management, case management)
- Ensure employees are current with clinical licensure and certifications
- Develop/oversee/deliver operational or technical training
/Implement/Manage Medical and Clinical Ops Programs
- Develop policies, procedures, and guidelines for medical and clinical operations programs
- Review/approve policy and process changes
- Evaluate regulatory changes and determine steps needed to implement in programs
- Develop medical and clinical operations program goals
- Identify and implement business development opportunities to support growth of medical and clinical operations programs
- Oversee/navigate technology and software applications utilized in the delivery of medical and clinical operations programs
- Oversee management/service delivery systems utilized in member care
- Intervene in resolution of member or employee complaints or issues as necessary
- Create and implement a business continuity plan to minimize interruptions to the business
Compliance of Medical and Clinical Ops Programs and Services
- Interpret compliance/clinical/medical reports
- Evaluate compliance with Federal, State, and Local regulatory and organizational guidelines
- Evaluate programs and services against accreditation standards
- Evaluate programs and services against contractual requirements
- Oversee ongoing monitoring and internal auditing against relevant guidelines and standards
- Implement process improvement activities to address areas of non-compliance or ensure procedures are followed
- Measure employee/provider performance against internal procedures and protocols
- Ensure team members address gaps in performance against internal procedures and protocols
/Evaluate Overall Medical and Clinical Ops Service, Employee Performance, and P
- Develop and communicate performance metrics and expectations
- Direct data collection and measurement of outcomes (e.g., customer surveys)
- Apply metrics to evaluate services, employee performance, and program outcomes
- Read and interpret reports (e.g., performance, service)
- Identify causes of performance deficiencies and determine appropriate follow up actions
- Drive implementation of best practices and standards
and Manage Medical and Clinical Operations to Ensure Financial Viability
- Develop operational budgets for medical and clinical operations
- Evaluate staffing ratios, stratification of care,…