Performance Improvement Patient Care Coordinator - Irvine, CA (112187334)
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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
- Healthcare professional with current knowledge of medical office and managed care business operations, responsible for providing patient support through telephonic coordination of clinical care and services
- Works collaboratively with departmental team members to implement programs to improve clinical quality
- Maintains a current knowledge of all quality-related Quality Incentive Programs (QIP) as they relate to individual health plan and government incentive programs
- Solid understanding and ability to translate Quality Measurement Specifications
- Serves as a liaison for internal and external customers in matters affecting members, providers, plans and other customers related to the interpretation and implementation of PI programs, activities, goals and policies
- Under the direction of the Manager, Performance Improvement, provides operational support in the implementation of initiatives related to PI programs, projects and related activities:
- Coordinates member education and reminders on evidence-based guidelines through telephonic outreach calls, educational mailings, IVR, secure Patient Portal emails, text messages, and community-based events
- Assesses and problem-solves patient challenges / barriers to receiving needed care and services
- Collaborates with providers and other partnering departments to implement patient care plans
- Coordinates patient care through correspondence and direct scheduling with providers
- Supports continuous quality improvement through research and testing of initiatives to assess success and scalability
- Manages data entry into the quality reporting application, analyzes data integrity and works with provider offices to provide support / education on correct use of the application
- Helps prepare and coordinate data validation audits
- Obtains proof-of-service documentation for member-reported services
- Assists in health plan data reconciliation efforts
- Keeps abreast of current industry guidelines, publications, events, and status reports for all QIP
- Attends conferences and meetings related to HEDIS/ Pay-for-Performance / CMS Stars/ ACO Quality Reporting as required
- Promotes open, clear, communication among company departments.
- Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and current Optum and client policies and procedures.
- Performs other related duties as required.
- Regular and consistent attendance. Attend in-services, training classes, and meetings relating to job tasks as required
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
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.
- High school diploma or GED; Bachelor’s degree from four-year accredited school
- 1+ years experience in a managed care environment or medical office equivalent experience
- Familiar with medical terminology
- Bilingual in one of the current Medi-Cal threshold languages with the ability to demonstrate fluency while speaking, reading and writing with sufficient accuracy and vocabulary appropriate to a healthcare setting
- 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.
- Experience in medical or pharmacy setting
- Excellent organizational and interpersonal skills
- Bilingual Spanish speaking
- Computer proficient with a minimum of Intermediate skill level in Microsoft Office
- EZ-CAP or similar database experience
- Reporting and analysis understanding
- Ability to read, analyze and interpret general business workflows
- Ability to communicate goals, strategies, and tactical plans
- Ability to document in a standard process flow application all process improvements
- Ability to effectively present information and respond to questions from internal departmental customers and other company departments
- Ability to work with mathematical concepts such as probability and statistical inference
- Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
- Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form
OTHER SKILLS and ABILITIES:
- Solid analytical, organizational and decision-making skills related to managed care business operations
- Thorough knowledge of HMO benefits, policies, procedures and regulatory requirements
- Proven written and verbal communication skills
- PC proficiency with strong word processing skills
- Able to travel locally up to 50% of the time to physician offices
COMPETENCIES: To perform the job successfully, an individual should demonstrate the following competencies:
- Teamwork - balances team and individual responsibilities; exhibits objectivity and openness to others’ views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; supports everyone’s efforts to succeed
- Planning/ Organizing - prioritizes and plans work activities; uses time efficiently
- Adaptability - adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events
- Attendance/ Punctuality - is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time
- Dependability - follows instructions, responds to management direction
- Takes responsibility for own actions; keeps commitments; completes tasks on time or notifies appropriate person with an alternate plan
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear
- The employee frequently is required to stand, walk and sit
- The employee is constantly required to use hands and fingers to handle or feel objects, tools, or controls and reach with hands and arms
- Travel by private auto to meetings outside of the main office on a routine basis
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Most work will take place in an office environment where the noise level is usually moderate
- The work can at times be extremely stressful, is deadline oriented and requires multi-tasking capabilities to successfully fulfill the job duties
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)
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.