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Job Details


UnitedHealth Group

Clinical Practice Performance Consultant

Healthcare

Clinical

No

East Brunswick, New Jersey, United States

Careers with Optum. We built an entire organization around one giant objective; make the health system work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on an elite team. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

As a Clinical Practice Performance Consultant, this position may include some 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)

Standard Hours: Monday - Friday 8AM - 5PM; Subject to change as needed

If you reside in New Jersey, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

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 that 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

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:

  • Associate's Degree OR 2+ years of nursing experience
  • Current, unrestricted RN license in the state the staff member resides in as well as any state member outreach is performed
  • Reliable transportation with a valid and unrestricted driver’s license, proof of insurance and the ability to travel to provider offices or other locations within service delivery area
  • 3+ years of clinical experience in a hospital, acute care, home health, direct care, or case management
  • Intermediate level of proficiency in using EMR, Microsoft Office, Excel, PowerPoint, Outlook, Internet Explorer, or other web browsers
  • Ability to travel to provider offices within service area – may require up to 2-hour radius for travel
  • 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 of Science 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

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So, when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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

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