Yuma, Arizona
Glen Burnie, Maryland
Posted: 28-Dec-24
Location: Louisville, Kentucky
Categories:
Internal Number: 145456375
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.
Employees in this position will work on-site or virtually as an extension of the local quality and provider teams by aligning to geographical regions, medical centers and/or physician practices that manage a high volume of UHC Medicare & Retirement membership. The person in this role is expected to work directly with care providers to build relationships, ensure effective clinical education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), look for gaps in care, perform telephonic assessments for preventative screenings and/or HEDIS gaps in care, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices daily. This position does not entail any direct member care* nor does any case management occur. (*except for participating in health fairs and/or health screenings where member contact could occur)
If you reside in Kentucky, Ohio, or Indiana, you’ll enjoy the flexibility to telecommute* as you take on some tough challenges.
Schedule: Monday to Friday; 8 AM – 5 PM EST
Primary Responsibilities:
- Assist in the review of medical records to highlight Star opportunities for the medical staff and assist in closing care gaps
- Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
- Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data
- Track appointments and document information completely and accurately in all currently supported systems in a timely manner
- Optimize customer satisfaction, positively impact the closing of gaps in care and productivity
- Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support the practice and our members ensuring that recommended preventative health screenings are completed and HEDIS gaps in care are addressed
- Interaction with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and/or providers to assist in scheduling appointments, closing gaps in care or chart collection activities
- Answer inbound calls from members and/or providers regarding appointments
- Communicate scheduling challenges or trends that may negatively impact quality outcomes
- Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs
- Provide ongoing support and education to team members and assist in removing barriers in care
- Manage time effectively to ensure productivity goals are met
- Ability to work independently in virtual settings. Ability to problem solve, use best professional judgment and apply critical thinking techniques to resolve issues as they arise
- Identify and seek out opportunities within one’s own workflow to improve call efficiency
- Adhere to corporate requirements related to industry regulations/responsibilities
- Maintain confidentiality and adhere to HIPAA requirements
- Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level
- Appointment coordination for specialist appointments, late to refill medication outreach and scheduling members for local market clinic events
- Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
- Other duties, as assigned
- Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare
- Weekly commitment of 50% travel for business meetings (including client/health plan partners and provider meetings) and 50% remote work
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
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 in the state of residence as well as any state member outreach is performed
- 3+ years of clinical experience in a hospital, acute care, home health, direct
- 1+ years of experience in case and/or care management
- Advanced level of proficiency in Excel, Outlook, and PowerPoint
- Weekly commitment of 60% travel for business meetings (including client/health plan partners and provider meetings) and 40% remote work
Preferred Qualifications:
- Bachelor of Science in Nursing
- Case Management experience including Certification in Case Management
- 1+ year of STARs experience
- Experience with HEDIS and EMR (electronic medical records)
- Consulting experience
- Strong knowledge of the Medicare market
- Knowledge base of clinical standards of care, preventive health, and Stars measures
- Experience in managed care working with network and provider relations/contracting
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Strong communication and presentation skills
- Strong relationship building skills with clinical and non-clinical personnel
- Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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: 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.
#RPO #Green
