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Careers at UnitedHealth Group

 

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:

Medical and Clinical Operations

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

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Clinical Quality Consultant - Field Based St Louis MO

UHG - St. Louis, Missouri

Posted: 12/10/2018

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

 

The successful candidate will be  responsible for 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, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.
 

If you are located in St. Louis, MO area you will have the flexibility to telecommute* as you take on some tough challenges.

 
Primary Responsibilities:
  • The Clinical Quality 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
  • Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
  • Medical records auditing from providers, practices
  • Execute applicable provider incentive programs for health plan
  • 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
  • Coordinate and lead Stars - specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, HQPAFs, 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


 


Required Qualifications:
  • Bachelor’s Degree required or equivalent work experience
  • 5+ years of healthcare industry experience
  • 3+ years of experience managing relationships with physicians / hospitals / health systems 
  • Strong knowledge of the Medicare market
  • Strong communication and presentation skills
  • Strong problem solving skills
  • Proven relationship building skills with clinical and non - clinical personnel
  • Microsoft Office specialist with exceptional analytical and data representation expertise; intermediate Excel, Outlook, and PowerPoint skills
  • Availability to travel locally up to at least 50% of the time
 
Preferred Qualifications:
  • CPC or CRC
  • Registered Nurse
  • Medical / clinical background
  • Medicare Starts Rating System (STARS) experience
  • HEDIS experience
  • Strong knowledge of electronic medical record systems
  • Consulting experience
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Experience in managed care working with network and provider relations / contracting
  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models
 
 
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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: Stars, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based, St Louis, Missouri, MO

 

 

 

 

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