Remote VP of Clinical Services and Quality RN – New Mexico

UnitedHealthcare

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Requisition Number: 2186067
Job Category: Medical & Clinical Operations
Primary Location: Albuquerque, NM
(Remote considered)

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

The leader of clinical services and quality oversees a team of Community Health Workers, Clinical Administrative Coordinators, Social Workers, Behavioral Health Advocates and RNs coordinating services telephonically and in the field. In this full-time hybrid role and the candidate must reside in New Mexico.  This person should expect 30% of their time traveling and visiting providers, clinics, and social service partners in the community. The candidate must have experience increasing quality measurements in a health plan or clinical setting.  This role is based in New Mexico.  The successful candidate will hold the following responsibilities.

If you are located within New Mexico, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

On an ongoing basis, this role leads health plan vendor oversight actions and transportation coordination, including:

  • Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws
  • Performs supervisory audits as necessary
  • Monitors team metrics and operational data
  • Interview, hire and onboard new employees
  • Overall responsibility for the supervision and coordination of all workflow activities related to case management team
  • Provides mentorship, coaching and training for team members while applying UHG values Integrity, Compassion, Relationships, Innovation and Performance
  • Supports excellent employee performance and encourage staff development
  • Assists with the development and implementation of departmental policies and procedures
  • Conducts regular meetings to review complex cases and changes in procedures
  • Completes special projects and tasks as assigned
  • Conducts field ride-alongs and evaluations for Community Health Workers in specific geographic locations in North Carolina
  • Host and develop agendas for virtual monthly staff meetings
  • 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)

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:

  • Current, unrestricted RN license or provider license in NM
  • BS or BSN or clinical health degree (behavior health/counseling)
  • 5+ years of experience as a Registered Nurse or a provider in a hospital, acute care, home health / hospice, direct care or case management
  • 3+ years of demonstrated leadership and team management / development skills
  • 3+ years of case management experience
  • Demonstrated proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
  • Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
  • Proven problem solving skills; ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Reside in New Mexico or willing to relocate
  • Willing and able to travel 30% +/- depending on business need

Preferred Qualifications:

  • Six Sigma certification, credentialed provider experience or clinical experience
  • CCM or working toward CCM (Certification in Case Management)
  • 3+ years of experience running a quality program with focus on HEDIS requirements and NCQA standards

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy