Market Nurse Leader RN Irving Dallas Fort Worth TX (873742)

Employment Type

: Full-Time

Industry

: Healthcare - Nursing



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
  • Position is based out of the Irving Office and will require extensive travel throughout the DFW market. 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 (or Bachelor of Science in Nursing with additional 2 years experience in lieu of Master's Degree)
  • Active, unrestricted Registered Nurse (RN) Texas
  • Eight or more years of related experience in a hospital or clinical setting, with three or more 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
  • 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
  • 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 350,000+ 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.

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