Nashville, Tennessee
Richmond, Virginia, Virginia
Selma, Alabama
South Carolina
Lancaster, Pennsylvania
Posted: 18-Dec-24
Location: Tampa, Florida
Categories:
Internal Number: 145271844
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.
If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Meeting with providers monthly
- Detailing provider incentive program and potential earnings per measure
- Presenting the provider’s unique Patient Care Opportunity Report
- Presenting analysis of rate trends and opportunities to meet goal
- Detailing findings of claims and medical record research
- Recommending specific action plans by measure - with incentive to be earned for meeting goal
- Strategizing on barriers and opportunities for remediation
- Educating on coding, documentation discrepancies and agreed upon action plans
- Providing educational materials on measures, detailing specifications of the measure and listing codes required for proper claim submission
- Function as liaison to community partners serving members in assigned populations
- Collaborate with Clinical teams to align programs for specific populations (i.e., disease management, case management, medication management, and clinical affordability)
- Review literature, feedback from committees, and other stakeholders to identify and document barriers to care for their assigned population(s)
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 Florida
- 3+ years of clinical experience with an emphasis on Medical/Surgical and Complex/Chronic Care, including a comprehensive understanding of coordination of care principles, developing shared integration tools and collaboration principles across a multidisciplinary team both internal and external
- 3+ years of quality improvement experience
- Experience working in the community, including face to face or telephonically with providers and across specialties (Primary Care, Pediatrics and Behavioral Health)
- Experience making formal presentations in front of committees and work group environments and using virtual technology (I.E: Microsoft Teams/Web X)
- Experience reviewing available literature and make recommendations for strategic improvements in member-, provider-, and community-facing programs, as well as to internal processes and systems
- Intermediate level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, Internet browsers, EMRs and Practice Management Software
- Reside in the state of Florida
Preferred Qualifications:
- Certified Professional in Healthcare Quality
- Experience integrating medical and behavioral health care in an outpatient setting
- Comprehensive understanding of Privacy Laws (HIPAA)
- Knowledge base of HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
- Knowledge of Health Information Exchanges (HIE), Electronic Medical Records (EMRs)
- Use of industry standard Quality Tools and Methodology
*All employees working remotely 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.
