Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Consultant provides clinical and operational support as a U.S. Healthcare Subject Matter Expert, providing various clinical support services and operational guidance for business processes, to include Case Management, Utilization Management, Clinical Coverage Preservice, Claims and Appeals review, Clinical Support and Notification, Inpatient Care Management, and Pharmaceuticals. This position will serve as Clinical Consultant to all Clinical Operations businesses, anticipating clinical needs and developing solutions that enhance clinical knowledge and clinical decision-making skills among frontline nurses. Solves complex problems while developing innovative solutions that meet business needs and supports implementation of those solutions among clinicians throughout the business operation. Assesses business education needs and develops clinical training programs to support a wide variety of clinical projects and educates employees on clinical foundation topics via in person and online training platforms. Utilizes appropriate clinical resources and guidelines, which include, but are not limited to U.S. (United States) state and federal mandates, national and local coverage determination, applicable internal UnitedHealthcare medical policies, formularies and updates, as well as, coverage determination guidelines, such as Milliman and InterQual.
Primary Responsibilities:
- Operational Management Functions:
- Collaborates with Solutioning and Transitions on new business needs: demo, staff profile, training content, timelines
- Assesses learning needs of individuals and teams within clinical business processes
- Develops learning goals, objectives, curriculum, and measurements that promote desired performance outcomes
- Creates and delivers complex clinical foundation content using adult learning principles and strategies with business consideration
- Leverages learning technologies and tools for presentation, collaboration, and engagement
- Facilitates and manages learning in web-based and/or face-to-face environments
- Reviews evaluative data to make improvements and/or establish new initiatives and business improvement solutions
- Maintains updates to curriculum and assessments based on changes and relevant feedback
- Establishes positive working relationships with all levels of staff and management
- Provides coaching, guidance, and feedback to learners
- Monitors new LOB until reaches steady state and conducts LOB Transition Support
- Provides Clinical Refresher and Upskilling Training for all LOBs as needed
- Conducts clinical acumen assessments during hiring and Attrition Review Support as needed (for non-RN led teams)
- Anticipates customer needs and proactively develops solutions to meet them
- Serves as a key resource on complex and/or critical issues
- Performs complex conceptual analyses to solves complex problems while developing innovative solutions
- Reviews work performed by others and provides recommendations for improvement
- Assesses and interprets clinical education needs and requirements for all businesses
- Works with minimal guidance seeks guidance on only the most complex tasks
- Coordinates with others to develop program or process implementation plans
- Works in a virtual team environment
- Performance Management Functions:
- Communicates and collaborates with operations managers and business partners to improve production quality and efficiency, develop best practices, and identify clinical process issues
- Provides explanations and information to others on difficult issues
- Identifies skill, knowledge, and certification requirements for program/process implementation, based on requirements
- Initiates a quality driven approach to identify root cause and process improvement opportunities
- Communicates and collaborates with key stakeholders,regarding findings and recommendations
- Develops an understanding of clinical and clinical support business needs (e.g., through process walk-throughs, audit findings, survey results, case reviews oradditional research, etc.)
- Performs, assists with, or oversees clinical quality audits
- Staff Development Functions:
- Coaches, provides feedback, and guides others
- Provides subject matter expertise to train others on clinical foundation topics
- Supports implementation of businessstrategies
- Develops talent in all levels to establish solid talent pipelinethrough education, training, and coaching
- Collaboratively works with Business Operations Manager to coordinate fortraining newhires, ensuring clinical foundationtraining timelines are met within agreedexpectations
- Reporting:
- Develops program/process tools and resources, based on communication and education requirements
- Identifies technology needs to support programs/processes (e.g., systems for use of the program)
- Obtains input and feedback from stakeholders during communication development
- Communicates educational progress and status of training programs with stakeholders
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- Bachelor of Science in Nursing
- Active unrestricted US Registered Nurse license in at least one US state or jurisdiction
- Active Philippine Registered Nurse license
- 3+ years of clinical nurse experience in U.S. healthcare system
- Solid knowledge of medical terminologies and U.S. healthcare processes
- Knowledgeable in Microsoft Office
- Proficient in creating power point presentations and excel documents
- Demonstrated effective verbal and written communication skills
Preferred Qualifications:
- MCG or IQ trained/certified
- Certification in Case Management or Managed Care
- 1+ years of clinical BPO process experience in Inpatient Clinical support, Case Management or Utilization Management
- 1+ years of experience training and/or educating Registered Nurses
- Demonstrated solid clinical acumen and awareness of the US healthcare system
- Demonstrated servant leadership style that collaborates well and is team-focused
- Demonstrated ability to work independently, taking the initiative to act with solid self-management skills
- Demonstrated ability to display calm under pressure with good control over emotional responsesand self-control during times of adversity, conflict, and change
- Demonstrated superior interpersonal/communication skills and able to communicate with large teams
- Demonstrated solid listening, verbal, and written communication skills
- Demonstrated solid training delivery techniques both for instructor led face to face or virtual training
- Demonstrated ability to prioritize multiple tasks and ensure all are monitored and tracked to completion
- Demonstrated solid organizational skills and multitasking abilities
- Demonstrated technical aptitude and proficiency with good analytical and decision-making skills
- Demonstrated solid capability on digital content creation, curriculum design and use of MS Office 365 apps and tools
- Demonstrated ability to value integrity and comply with company's regulations and policies
- Demonstrated ability to provide clear directions and set specific expectations
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: Optum 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.
Optum is a drug-free workplace. 2024 Optum Global Solutions (Philippines) Inc. All rights reserved.
