Optum at Home Director, Medical Clinical Ops - Oklahoma

Home Base Medical Care, part of the Optum family of businesses, is seeking a Director Medical Clinical Ops to join our team in Tulsa, OK. Optum is a clinician-led care organization that is changing the way clinicians work and live.

Home Based Medical Care involves travel to patient residences. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Optum at Home Program (OAH) is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The OAH program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member's Primary Care Provider and other providers, and other professionals. Optum providers serve patients in their own homes through annual comprehensive assessments, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management. The program's interdisciplinary care team approach provides needed care in person and through Virtual and telephonic interventions in collaboration with the members Primary Care Provider and other members of the interdisciplinary care team.

Goals / Outcomes of Program:

• The overall goals of the Optum at Home Program are multi-faceted and include:
• Improved cost savings through reduced:
• Medical expenses
• Acute admissions
• Acute Readmissions
• ER Visits
• Accurate coding of all acute and chronic diagnoses including an supporting individualized plan of care
• Appropriate preventative care, closure of appropriate Star gaps
• Taking a holistic approach to the member, a single point of contact helps to navigate the member's complex chronic health challenges and / or socioeconomic needs. The navigator draws on the Interdisciplinary Care Team to support the member's unique needs

The Director of Clinical Operations will work closely with the product team to develop and launch the clinical model for the OAH membership, including the development of workflows, processes, and clinical tools and reporting. The role will also help build, support, train, and mentor the clinical team necessary to support the model. Direct management responsibilities may also be part of this role.

Primary Responsibilities:

• Strategize, develop, and direct operations of the OAH community program, in collaboration with the clinical and product teams,to ensure provision of high quality, cost-effective medical services are provided for this membership
• Responsible for market clinical staff performance including recruitment, retention, and development of clinical staff
• Put forth recommendations on innovations and process improvements as appropriate
• Track/monitor trends, gaps, and regularly analyze data related to clinical delivery model occasionally presenting info to internal or external stakeholders
• Lead, supervise, and develop members of the OAH clinical team (2 6 directs, 30 60+indirect)
• Drive clinical success around the above program metrics / targets
• Collaborate with the national OAH clinical team on clinical initiatives and model development
• Ensure compliance with State and Federal regulations, as well as company policies and procedures
• Ensure compliance of the model with the CMS model of care requirements for Special Needs Plans
• Ensure high quality focus embedded into clinical model for OAH includes Stars and accurate coding and documentation
• Development of clinical staffing models based on enhanced and / or newly developed clinical model(s)
• Strategize and evaluate methodologies for program adaptation and integration within partnering organizations- support growth with internal and external partners
• 25% travel in market for program assessment, evaluation, education, promoting initiatives

Home Base Medical Care, a part of Optum, was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides home-based medical care to patients. Our clinical teams can spend quality-time caring for a smaller number of patients, giving all patients the space, respect, compassion and care they deserve. At Home Base Medical Care, our interdisciplinary teams collaboratively manage our complex patient panels. Join Home Base Medical Care to be part of a growing company full of purpose-driven, action-oriented, and compassionate team members working to dramatically transform healthcare for our communities. Together, we're making health care work better for everyone.

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:

• RN, NP or PA with an active, unrestricted license
• 5+ years of clinical experience
• 5+ years of total experience working in OAH and/or Medicaid environment
• 3+ years of leadership experience
• 2+ years of experience analyzing data, gaps in care related to clinical delivery model
• 2+ years of hands-on experience with HEDIS, Stars, quality initiatives
• Experience developing and implementing policies, procedures
• Willing or ability to travel 25% regularly within market, also occasional national as needed for leadership meetings

Preferred Qualifications:

• Experience successfully driving to metrics
• Proficient with Microsoft Word, Excel, Outlook, PowerPoint
• Proven track record of solid performance management and developing teams
• Proven excellent written and verbal communication and relationship building skills
• Proven planning and organizational skills to demonstrate leadership and initiative
• Demonstrated ability to manage multiple complex, concurrent projects
• Demonstrated ability to work independently as well as a member of a team

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.