Senior Practice Performance Specialist – Remote in KY

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. 

Employees in this position will work on-site or virtually as an extension of the local quality and provider teams by aligning to geographical regions, medical centers and/or physician practices that manage a high volume of UHC Medicare & Retirement membership.  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)

Schedule: Monday to Friday; 8 AM – 5 PM

If you are located within KY, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Functioning independently, virtually meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
• Execute support for the 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
• Track appointments and document information completely and accurately in all currently supported systems in a timely manner
• Optimize customer satisfaction, positively impact the closing of gaps in care and productivity
• Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support the practice and our members ensuring that recommended preventative health screenings are completed and HEDIS gaps in care are addressed
• Interaction with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and/or providers to assist in scheduling appointments, closing gaps in care or chart collection activities
• Answer inbound calls from members and/or providers regarding appointments
• Communicate scheduling challenges or trends that may negatively impact quality outcomes
• Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs
• Provide ongoing support and education to team members and assist in removing barriers in care
• Manage time effectively to ensure productivity goals are met
• Ability to work independently in virtual setting. Ability to problem solve, use best professional judgment and apply critical thinking techniques to resolve issues as they arise
• Identify and seek out opportunities within one’s own workflow to improve call efficiency
• Adhere to corporate requirements related to industry regulations/responsibilities
• Maintain confidentiality and adhere to HIPAA requirements
• Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level
• Appointment coordination for specialist appointments, late to refill medication outreach and scheduling members for local market clinic events
• Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
• Field based activities require the abilities to support appropriate targeted providers
• Work internally with support team on ad-hoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
• Participate and engage with team on member or provider campaigns which may include documentation tracking, member outreach, data analysis and data entry
• Support incentive account owners on strategy development, feedback and participate within monthly meetings to give updates on member outreach or quality measure closures
• Support EMR data exchange initiatives with incentive program owner to establish data communication between provider group and UHC
• Weekly commitment of 60% travel for business meetings in Kentucky, Southern Ohio, and Southern Indiana (including client/health plan partners and provider meetings) and 40% remote work
• Other duties, as assigned

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:

• High School Diploma/GED (or higher)
• 3+ years of clinical experience in a hospital, acute care, home health, direct care or case management
• 2+ years of experience as a Microsoft Office specialist with exceptional analytical and data representation expertise including advanced Excel, Outlook, and PowerPoint skills
• 2+ years of experience with member/patient outreach and management of member/patient support services
• 1+ years of experience as an account manager or in a sales/service role
• Weekly commitment of 60% travel for business meetings in Kentucky, Southern Ohio, and Southern Indiana (including client/health plan partners and provider meetings) and 40% remote work
• 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

 Preferred Qualifications:

• Bachelor of Science in Nursing
• Current, unrestricted RN or LPN license in the state of residence as well as any state member outreach is performed
• Case Management experience including Certification in Case Management
• 1+ year of STARs experience 
• Experience with HEDIS and EMR (electronic medical records)
• Consulting experience highly preferred
• Strong knowledge of the Medicare market
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Experience in managed care working with network and provider relations/contracting
• Strong problem-solving skills
• Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Strong communication and presentation skills
• Strong relationship building skills with clinical and non-clinical personnel

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

The salary range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

 

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.

 

 

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