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 thats improving the lives of millions. Here, innovation isnt about another gadget, its about making health care data available wherever and whenever people need it, safely and reliably. Theres no room for error. Join us and start doingyour lifes best work.(sm)

The Practice Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers 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), identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity. Work is primarily performed at physician practices on a daily basis.
If you are located within an hour of Rochester, NY, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities

Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and incentive programs focused on improving the quality of care for Medicare Advantage Members
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs
Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes
Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Provider Scorecard) to analyze data and prioritize gap closure, identify trends and drive educational opportunities
Conduct chart review quarterly and provide timely feedback to provider to implement change on a go forward basis
Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), risk adjustment coding practices, and Optum program administration, use of plan tools, reports and systems
Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Collaborates and communicates with the members health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
Includes up to 75 local travel

Youll 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

CPC (Certified Professional Coder) or CRC (Certified Risk Coder)
5 years of experience in the healthcare industry
1 years of provider facing experience, including leading presentations
Experience retrieving data from EMRs (electronic medical records)
Experience building relationships with both clinical and non-clinical personnel
Solid knowledge of Medicare Advantage, including STARS and Risk Adjustment
Solid knowledge of clinical standards of care and preventive health
Able and willing to accommodate up to 75 local travel within the Rochester area
MS Excel proficiency of at least intermediate
Ability to use Excel to analyze and represent data
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

Careers with Optum. Heres 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 worlds 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 lifes best work.(sm)
* All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Diversity creates a healthier atmosphereUnitedHealth 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 drugfree workplace. Candidates are required to pass a drug test before beginning employment.
Job KeywordsPractice Performance Medicare Consultant, Rochester, NY, New York, Work At Home, Remote, Work From Home, Telecommute, Telecommuter, Telecommuting

Requisition Number:932552

Business Segment:OptumInsight

Employee Status:Regular

Job Level:Individual Contributor

Travel:Yes, 75 % of the Time

Country:US

Overtime Status:Exempt

Schedule:Full-time

Shift:Day Job

Telecommuter Position:Yes