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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:
- Medical expense
- Acute admissions
- Acute Readmissions
- ER Visits
- 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
- 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
- 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
- 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