Practice Performance Consultant - Remote
Company: UnitedHealth Group
Location: Indianapolis
Posted on: November 19, 2023
Job Description:
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. -
This is a field based position traveling to physician practices.
Case managers review charts (paper and electronic - EMR), look for
gaps in care, perform assessments, help coordinate doctor
appointments, make follow-up calls to members after appointments,
and assist our members in overall wellness and prevention. Case
managers primarily work at physician practices on a daily basis.
-
If you are live in the Eastern/Western PA regional area for travel
purposes, you will have the flexibility to work remotely* as you
take on some tough challenges.
Primary Responsibilities:
- Conduct telephonic member needs assessments according to state
and national guidelines, policies, procedures, and
protocols
- Interact with patients via telephone; Schedule appointments,
Follow up calls to assess understanding of services, answer
questions and ascertain that additional procedures have been
completed
- Provides care coordination/case management through physician
practices for members to improve clinical quality and clinical
documentation. No direct patient 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 patient appointments and data between
visits
- Create and maintain a professional and supportive relationship
with the patient, 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
care needs for the member
- Provides education to members regarding health care needs and
available - services
- Works to facilitate member compliance with their care/treatment
plan and to ensure continuity of care
- Identifies barriers to optimal care and outcomes or clinical
concerns and communicate with members and providers to formulate
action plan to address
- Documents all care coordination activities and interventions in
the member's health plan clinical record
- 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:
- Current, unrestricted RN license in the State of
Pennsylvania
- 3+ years clinical experience in a hospital, acute care, home
health, direct care or case management
- Proficient experience entering/retrieving data in electronic
clinical records
- Proficient experience with MS Office products (i.e., Word,
Excel, PowerPoint)
- Ability to travel to provider offices within service area
approximately 25% of the time as business needs dictate - may
require up to 2 hour radius for travel (Eastern and Western PA
regional areas)
- Ability to provide proof of a valid and unrestricted driver's
license, proof of insurance and ability to travel to provider
offices or other locations within service delivery area (Eastern
and Western PA regional areas)
Preferred Qualifications:
- Bachelors 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
- 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 in order to
understand and align with their needs and realities
- Demonstrated ability to perform effective active listening
skills to empathize with the customer in order to develop a trust
and respect
- Demonstrated ability to take responsibility and internally
driven to accomplish goals and recognize what needs to be done in
order to achieve a goal(s)
- Demonstrated ability to turn situations around and go above and
beyond to meet the needs of the customer
*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.
Keywords: UnitedHealth Group, Indianapolis , Practice Performance Consultant - Remote, Professions , Indianapolis, Indiana
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