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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Admin Support Services



Approximate Salary:

Not Specified

Position Type:

Full Time

Clinical Administrator, In - Home, Dual Special Needs Plan (DSNP) - Philadelphia, PA Telecommute

UHG - Philadelphia, Pennsylvania

Posted: 12/17/2018

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

The Clinical Administrator, In - Home, Home, Dual Special Needs Plan (DSNP) at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member’s Primary Care Provider and other providers, and other professionals. Optum providers serve patients’ in their own homes through annual comprehensive assessments, ongoing visits for higher risk members, care coordination during transitions from the hospital or nursing home and ongoing care management. The program’s interdisciplinary care team approach provides needed care in person and through telephonic interventions in collaboration with the members Primary Care Provider and other members of the interdisciplinary care team.

Goals / Outcomes of Program


The overall goals of the DSNP at Home Program are multi - faceted and include:

Improved cost savings through reduced:
  • Medical expense 
  • Acute admissions
  • Acute Readmissions
  • ER Visits
Accurate coding of all acute and chronic diagnoses including an supporting individualized plan of care 
Appropriate preventative care,  closure of appropriate Star gaps
Taking a holistic approach to the member, a single point of contact helps to navigate the member’s complex chronic health challenges and / or socioeconomic needs. The navigator draws on the Interdisciplinary Care Team to support the member’s unique needs
The Clinical Administrator is an administrator role with a medical background and assists the DSNP At Home program with the performance of administrative functions to support clinical care team and assist in support of program goals. Position is responsible for collaborating with interdisciplinary care team and provides program support to Advanced Practice Clinicians, RNs, and Behavioral Health Clinicians and management. This position is integral part of interdisciplinary care team to meet model of care guidelines and support clinical staff and members in the At Home program.


Primary Responsibilities:
  • Support market as clinical administrator and complete assigned tasks for tracking and monitoring report
  • Assist with enrollment and scheduling of new members in the system to ensure accurate data and member information in systems
  • Research member - related health information (e.g., medications, clinical records, policies, benefit information) using internal and external systems desk top computer applications (e.g., Excel, Word, Outlook, Office Communicator) and HER to summarize information (e.g., reports) or communicate member information to others.
  • Navigate multiple applications at once to obtain and / or document member information
  • Learn updates and changes to computer systems / applications and apply to navigate applications effectively
  • Execute and meet performance goals within a virtual environment 
  • Document outreach, visit activity and case information completely, accurately, and in a timely manner in EHR
  • Maintains and updates member’s risk level as directed
  • Identify and update demographics, member contact info and care levels in EHR
  • Fax APCs encounters to PCPs if EMR auto - fax not available
  • Monitors EMR for note completion and assigns patients to appropriate provider and program
  • Develops program reports for internal and external customer
  • Coordinate supplies for providers in the field, ordering, distributing etc.
  • Perform data collection, data entry and quality monitoring activities, as applicable
  • Monitor, track and document admissions and discharges in the EHR.
  • Provide daily support  to APC’s, RNs and Behavioral Health Clinicians telephonically as needed (confirm addresses, phone numbers, reschedules, cancellations)
  • Ensure appropriate telephonic follow up with members and community resources to coordinate services

Required Qualifications:
  • High School Diploma / GED or higher
  • 2+ years of office management or working in a professional office setting
  • Requires up to 25% travel to the local Philadelphia office quarterly
  • Proficient with Microsoft Word (creating and editing documents) and Excel (general spreadsheet navigation, sorting, filtering and exporting data)
  • Working knowledge or EMR (electronic medical record) systems such as Pathway or other related EMR systems

 Preferred Qualifications:

  • Background in clinical administrative position
  • Proficient with Microsoft Excel using V - lookups and / or Pivot Tables
  • Experience working within the Healthcare Industry
  • Experience working with Healthcare Insurance
  • Experience working in a Hospital, Physician's Office, or Medical Clinical setting.
  • Professional experience in a clerical or administrative support related role
  • Experience working with Medicare and / or Medicaid Services
  • Experience working in a call center environment
Soft Skills:
  • Demonstrate a high level of customer service
  • Must be able to talk & type at the same time while servicing the clinical team

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.


Keywords: Philadelphia, PA, Optum, UnitedHealth Group, UHG, Clinical Administrator, In - Home, Duals Special Needs Plan

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