Regional HIM Manager - OptumInsight

UnitedHealth Group; Bakersfield (CA); On-site; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group is seeking a leader for Medical & Clinical Operations, overseeing professional staff and coordinating programs to ensure compliance and performance. The role emphasizes staff development, operational governance, and financial viability across medical operations.

Required HIM management experience and healthcare background, with licensure requirements and preferred certifications to strengthen program oversight.

Qualifications

• 3+ years of HIM management experience.
• 2+ years of health care experience.
• Driver’s License and access to a reliable transportation.
• Epic HIM Certification
• RHIT or RHIA credential

Responsibilities

• MCG_Review and implement medical and clinical protocols for staff oversight and development.
• Plan/Implement/Manage Medical and Clinical Ops Programs.
• MCG_Ensure Compliance of Medical and Clinical Ops Programs and Services.
• MCG_Monitor/Evaluate Overall Medical and Clinical Ops Service, Employee Performance, and P.
• MCG_Plan and Manage Medical and Clinical Operations to Ensure Financial Viability.

Job description

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:

• MCG_Review 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
• MCG_Plan/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
• MCG_Ensure 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
• MCG_Monitor/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
• MCG_Plan and Manage Medical and Clinical Operations to Ensure Financial Viability
  • Develop operational budgets for medical and clinical operations
  • Evaluate staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses
  • Read financial reports, identify reasons for financial performance gaps, and identify opportunities for improved financial performance and enhanced return on investment
  • Collect and review data to evaluate financial outcomes of programs and services
  • Conduct cost/benefit analysis on programs to drive efficiencies
  • Conduct competitive analysis and identify opportunities to enhance financial viability
  • Propose and obtain approval for capital expenditures for medical and clinical operations

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:

• 3+ years of HIM management experience
• 2+ years of Health care experience
• Driver’s License and access to a reliable transportation

Preferred Qualifications:

• Epic HIM Certification
• RHIT or RHIA credential

Values Based Competencies

Employee

• Integrity Value: Act Ethically
  • Comply with Applicable Laws, Regulations and Policies
  • Demonstrate Integrity
• Compassion Value: Focus on Customers
  • Identify and Exceed Customer Expectations
  • Improve the Customer Experience
• Relationships Value: Act as a Team Player
  • Collaborate with Others
  • Demonstrate Diversity Awareness
  • Learn and Develop
• Relationships Value: Communicate Effectively
  • Influence Others
  • Listen Actively
  • Speak and Write Clearly
• Innovation Value: Support Change and Innovation
  • Contribute Innovative Ideas
  • Work Effectively in a Changing Environment
• Performance Value: Make Fact-Based Decisions
  • Apply Business Knowledge
  • Use Sound Judgement
• Performance Value: Deliver Quality Results
  • Drive for Results
  • Manage Time Effectively
  • Produce High-Quality Work

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 are 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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group 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.

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