Job Description

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)

The Practice Performance Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics. The person in this role is expected to work directly with care providers and members to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), look for gaps in care, perform telephonic member engagement, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention.

If you are located in the state of CA, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

* Make outbound calls and receive inbound calls to members for appointment scheduling, member education, program referral
* Execute applicable provider incentive programs for health plan
* Assist in the review of medical records to highlight Star opportunities for the medical staff
* Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities
* Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data and will be supervised by licensed and/or certified staff
* Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
* Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
* Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
* Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems
* Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
* Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
* Provide suggestions and feedback to Optum and health plan
* Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
* Other duties, as assigned

Includes up to 25% local travel.

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:

* Registered Nurse with active license in state of California
* 3+ years of healthcare industry experience
* 1+ years of experience working for a health plan and/or a provider's office
* Strong communication and presentation skills as well as data representation expertise
* Strong relationship building skills with members, clinical and non-clinical personnel
* MS Office proficiency (at least intermediate in Outlook, Word, Excel, & PowerPoint)
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

* Experience with STARs measures
* Experience in managed care working with network and provider relations / contracting
* Strong knowledge of EMR systems
* Strong knowledge of the Medicare market
* Knowledge base of clinical standards of care and preventive health

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.

Job Keywords: Practice Performance Consultant RN, Registered Nurse, Hospital, Acute Care, Direct Care, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Sacramento, CA, California