Clinical Practice Performance Consultant RN

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

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.

If you are located in Albany, GA, you will have 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 members, 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 plans 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 higher) in Nursing
• Current, unrestricted RN license in the State of Georgia
• 3+ years of clinical experience in a hospital, office setting, acute care, home health, direct care, or case management
• Intermediate level of proficiency with 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
• Ability to travel 50% of the time to provider offices within service area - may require up to 100-mile radius for travel
• Proof of insurance and ability to travel to provider offices or other locations within service delivery area
• Access to reliable transportation, valid and unrestricted US driver's license

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

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
• Ability to identify with a consumer to understand and align with their needs and realities
• Ability to perform effective active listening skills to empathize with the customer to develop trust and respect
• Ability to take responsibility and internal driven to accomplish goals and recognize what needs to be done to achieve a goal(s)
• Ability to turn situations around and go above and beyond to meet the needs of the customer

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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