Submission for the position: Field Based Clinical Practice Performance Consultant RN - (Job Number: 2068541)
Field Based Clinical Practice Performance Consultant RN
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 health care 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. (*except for participating in health fairs and/or health screenings where member contact could occur)
Location : NE Hillsborough County in Florida. This role is home-based but will require travel at least 75% of the time. Reside in Tampa, FL area for easy commute to locations .
Work Schedule : Monday through Friday 8:00am-5:00pm
Primary Responsibilities:
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Provides care coordination through physician practices for members to improve clinical quality and clinical documentation
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May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
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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
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Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice
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Partner with the practice's administrative and clinical staff while managing member appointments and data between visits
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Create and maintain a professional and supportive relationship with the member, provider and office staff
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Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services
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Assists the member to access community, Medicare, family and other third-party resources as appropriate
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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
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Provides education to members regarding health care needs and available services related to preventative health screenings or HEDIS gaps in care
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Works to facilitate member compliance with their appointments, screenings, medications and/or action plans to complete open care opportunities/HEDIS gaps in care
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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
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Documents member conversations and activities in Optum/UHC programs.  No documentation in provider EMRs and/or member charts
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Maintains a focus on timely, high-quality customer service
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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:
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Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
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Medical Plan options along with participation in a Health Spending Account or a Health Saving account
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Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
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401(k) Savings Plan, Employee Stock Purchase Plan
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Education Reimbursement
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Employee Discounts
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Employee Assistance Program
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Employee Referral Bonus Program
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Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
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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:
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Associate degree or higher in nursing
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Current, unrestricted RN license in the State of Florida, as well as any state member outreach is performed
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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
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3 years clinical experience in a hospital, acute care, home health, direct care or case management
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Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and Excel
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Must be able to travel to provider offices within service area – may require up to 1-hour radius for travel
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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:
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Bachelor of Science in Nursing
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Bilingual
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Case Management experience including Certification in Case Management
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Experience with HEDIS and EMR (electronic medical records)
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Experience with navigating and analyzing reports in Microsoft Excel
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Medicaid, Medicare, Managed Care experience
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Prior Physician Office experience
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Home care/field-based case management
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Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
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Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
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Call Center experience
Soft Skills:
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Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities
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Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect
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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)
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Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
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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
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Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
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.
Job Keywords: Quality, Practice, Performance, Manager, quality measures, HEDIS, STARS, Medicare, provider, field based, travel, Tampa, Florida, FL #RPO, #red
Case Management
US-FL-Tampa
UHC & Optum Partners
May 10, 2022, 11:59:56 AM
Schedule: Full-time Location(s): US-FL-Tampa