RN Director Clinical Data Operations Lubbock TX

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our 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, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is 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)

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic stat that understands and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

Director, Clinical Data Operations - responsible for planning, organizing and directing the operation and administration of all DataRAP department operations. Coordinates departmental duties with appropriate personnel to meet program needs, ensures compliance with state and federal health plan requirements and (CMS) Medicare guidelines. Develops and implements policies, procedures, and updates and integrate current clinical practice guidelines. The success of this position requires the ability to foster communication and teamwork between physicians, clinic staff, disease management staff, corporate departments, vendors, and senior leadership. The director will provide long-term planning and oversight to maintain operations of the department assuring activities are appropriately integrated into strategic direction, as well as the mission and values of the company. Works cooperatively with the Director of Quality and Training to meet the training needs of entire the network of providers and staff.

Primary Responsibilities:
  • Directs and facilitates departmental functions for the health plan, medical group and other related entities
  • Communicates and provides the direction to coordinate the work activities of the management team and nursing/clinical staff in the DR department
  • Ensures the timely preparation of reports, budgets, and records for dissemination to stakeholders
  • Provides and implements strategic goals per market to in a timely manner and communicates to stakeholders
  • On an ongoing basis, assess the nurse staffing needs of the department based on the volume of work and the departmental production goals, and make adjustments to maintain quality service
  • Administers and supervises recruitment and hiring practices for the department
  • Interacts directly with all health plans, medical groups and senior leadership and acts as a resource to all internal and external customers
  • Ensures departmental operations, policies and procedures are compliant with health plan standards, accreditation standards and state/federal regulatory agencies.
  • Administers and supervises the implementation of all departmental policies and programs
  • Provides oversight to managers and promotes personal growth and development for team members
  • Works with key members of other WMMI departments to facilitate internal and external processes
  • Ensures accuracy, security and confidentiality of all member and personnel records
  • Provides excellent customer service, monitors quality service and customer service delivery by nursing staff
  • Serves on and chairs corporate committees, task forces, and/or work groups
  • Directs and assists the management team when needed in performance appraisals and employee counseling
  • Communicates process changes related to training needs of the providers and the employees to the Director of Quality and Training for development
  • Performs all other related duties as assigned

$5,000 Sign-on Bonus for External Candidates!

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:
  • Bachelor of Science in Nursing, Healthcare Administration or a related field (Eight additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
  • Current Registered Nurse (RN) license in applicable state
  • CPC certification or ability to obtain one within 9 months from the American Academy of Professional Coders
  • 5+ years of management / supervisory experience in a health care environment
  • 5+ years of clinical RN experience
  • 3+ years of ICD-9 diagnostic coding and supervisory experience
  • Knowledge of the following required: federal and state laws relating to managed care, basic principles and practices of clinical nursing, referral processes, claims, case management, contracting and physician practices
  • Strong knowledge of ICD-9 coding processes with excellent analytical and data mining skills
  • Ability to effectively plan programs and evaluate accomplishments, present findings in executive-level reports and presentations and exercise sound problem-solving and decision-making skills
  • Ability to effectively manage various levels of staff, projects, planning, and implementation of programs and processes and evaluate outcomes
  • Proficiency with Microsoft Office applications and other DataRAP database programs
  • Ability to travel as deemed necessary

Preferred Qualifications:
  • Master of Science in Nursing, Healthcare Administration or a related field
  • Certified Professional Coder (CPC)
  • Medical coding operations management experience

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)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: RN, Data, Operations, Healthcare, Clinical, TX, Texas, Lubbock, coding, Director, Manager, mgr, registered nurse, cpc, risk adjustment