OptumCare Arizona is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Care Arizona’s focus is to do the right things for patients, physicians, and the community. OptumCare Arizona’s core business is partnering with providers to deliver patient centered case management. The current focus of OptumCare Arizona is on seniors, and those with complex care needs, who most benefit from a high touch model of care.
The Quality Analyst and Educator role is responsible for the development of training and provision of the education for OptumCare AZ Medical Management staff. This role encompasses quality areas that include documentation standards, patient interaction, as well as development and oversight of Complex Case Management accreditation for all of the OptumCare Arizona Medical Management Department.
- Integration of UnitedHealth Group Values into everyday work practices
- Working with multiple co-morbidities and special programs for defined complex populations
Develop new and update all existing training curriculum, learning objectives and collateral materials for OptumCare Arizona medical management department.
- Development and implementation of role playing scenarios for Case Management staff
- Medication Review through transitions of care
- Motivational interviewing
- Utilization of evidence based medicine (EBM) standards, Case Management Guidelines (CCMC) along with the most current Medicare Guidelines
System platform for documentation of all patient related activities and interventions
- Patient care plans, use of SMART goals, and patient interactions with time frames
- Primary point of contact for questions relating to the systems
- Documentation, clinical and program concepts
- Develop auditing process for all clinicians while collaborating with Quality area to develop standardized metrics for auditing purposes.
- Complete documentation and home visit audits at site visits per departmental requirements.
- Report audit results to assigned management team and implementation of mentoring based on results.
- Cross trained to fill in for Case Managers in a staff emergency situation
- Chair of ongoing case management accreditation team to manage all related current and future accreditation activities
- Chair Quality Management system
- Collaborate with Project team to develop, organize, and execute new project plans
- Collaboration with respective departments to identify, track and develop policy and procedures for the medical management department.
- RN with an active, unrestrictive license in AZ
- 3+ years of experience within a clinical setting working with adults with complex, multiple co-morbidities within a senior population
- 2+ years providing case management
- RN with education / training background, quality initiatives or curriculum development
- Excellent communication skills verbal, written, presentation along with interpersonal skills
- Background in coaching and motivational techniques
- Background in Geriatrics and / or working with a Medicare population
- Proficient with computers and experience with MS Office: Word, PowerPoint, Visio and Excel
- Bachelor’s / Master’s preferred and a degree related to training
- Active Case Management Certification (CCM) or required within 2 years of hire
- Background in Quality
- Background in Accreditation process (NCQA / URAC)
- And/ or Successful involvement in NCQA / URAC CM and / or DM Accreditations
- Medicare and CMS background
Diversity creates a healthier atmosphere: 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: RN Case Manager, Case Management, CCM, Clinical Trainer, Optum, Complex Care, EBM, NCQA, CMS, JOC, AUDITS, Phoenix, AZ, Arizona