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UnitedHealth Group

Field Based - Clinical Practice Performance Consultant - Christiansted, St. Croix

Healthcare

Clinical

No

Christiansted, Virgin Islands, United States

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.SM

This is a field-based position traveling to physician practices. Advocates review charts (paper and electronic - EMR), look for gaps in care, perform STARs assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Advocates primarily work at physician practices daily. This position does not entail any direct member care* nor does any case management occur. (*with the exception of participating in health fairs and/or health screenings where member contact could occur).

This position is full-time, Monday - Friday. Employees are required to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm.

Primary Responsibilities:

  • Provides care coordination through physician practices for members to improve clinical quality and clinical documentation
  • May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
  • May interact with members via telephone; Schedule appointments, Follow-up calls to assess understanding of services, answer questions and ascertain those additional procedures have been completed that relate to preventative health screenings or HEDIS gaps in care
  • Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice
  • Partner with the practice's administrative and clinical staff while managing member appointments and data between visits
  • Create and maintain a professional and supportive relationship with the member, provider, and office staff
  • Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services
  • Assists the member to access community, Medicare, family, and other third-party resources as appropriate
  • Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the appointments, screening or care related to preventative health screenings or HEDIS gaps in care
  • Provides education to members regarding health care needs and available services related to preventative health screenings or HEDIS gaps in care
  • Works to facilitate member compliance with their appointments, screenings, medications and/or action plans to complete open care opportunities/HEDIS gaps in care
  • Identifies barriers for compliance in preventative health screenings or HEDIS gaps in care and communicates with members and providers to formulate action plan to address
  • Documents member conversations and activities in Optum/UHC programs. No documentation in provider EMRs and/or member charts
  • Maintains a focus on timely, high-quality customer service
  • Maintains the confidentiality of all sensitive information

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:

  • Associates Degree in Nursing
  • Current, unrestricted RN license in the State the staff member resides in as well as any state member outreach is performed.
  • Reliable transportation, valid and unrestricted driver’s license, proof of insurance and ability to travel to provider offices or other locations within service delivery area
  • 3+ years clinical experience in a hospital, acute care, home health, direct care, or case management
  • Experience with computers / typing to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including Microsoft Outlook and Microsoft Excel
  • Must be able to travel to provider offices within service area – may require up to 1-hour radius for travel
  • Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.

Preferred Qualifications:

  • Bachelor’s Degree in nursing
  • Case Management experience including Certification in Case Management
  • Experience with HEDIS and EMR (electronic medical records)
  • Experience with navigating and analyzing reports in Microsoft Excel
  • Medicaid, Medicare, Managed Care experience
  • Prior Physician Office experience
  • Home care/field-based case management
  • Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
  • Call Center experience

Soft Skills:

  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • 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
  • Demonstrated ability to identify with a consumer to understand and align with their needs and realities
  • Demonstrated ability to perform effective active listening skills to empathize with the customer to develop a trust and respect
  • Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done to achieve a goal(s)
  • Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $26.15 - $46.63. The salary range for Connecticut / Nevada / New York City residents is $28.85 - $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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, #RED

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