We all agree that health care can perform better if we continue to challenge the status quo. Right? That's why people like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are composed and compensated. Your expertise in provider networks can help us build in the next phase of evolution. In this managerial role, you'll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.
The Practice Consultant is responsible for program implementation and provider performance management, which is tracked by designated provider metrics including 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. The person will review charts (paper and electronic - EMR), identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity. Work is primarily performed at physician practices on a daily basis.
• Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and incentive programs focused on improving the quality of care for Medicare Advantage Members
• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
• Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes
• Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Provider Scorecard) to analyze data and prioritize gap closure, identify trends and drive educational opportunities
• Conduct chart review quarterly and provide timely feedback to provider to implement change on a go forward basis.
• Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution.
• Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), risk adjustment coding practices, and Optum program administration, use of plan tools, reports and systems
• Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
• Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
• Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
• Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
• Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
If you are located in either Cumberland county or York County, you will have the flexibility to telecommute* as you take on some tough challenges.
• HS diploma or equivalent
• 5+ years of healthcare industry experience
• Strong knowledge of Medicare Advantage including Stars and risk adjustment
• Experience with Microsoft Office suite, including an advanced proficiency with MS Excel
• Ability to travel 75% within designated market
• Certified Risk Coder(CRC), Certified Professional Coder(CPC) or currently pursuing one of these certifications
• Registered Nurse (RN)
• Experience working for a health plan and/or within a provider office
• Experience with network and provider relations/contracting
• Knowledge base of clinical standards of care and preventive health
• Experience retrieving data from EMRs (electronic medical records)
• Strong communication, presentation and relationship building skills with clinical and non-clinical personnel
• Strong problem-solving skills
Building diverse, high quality provider networks is creating greater access to health care and improving the lives of millions. Join us. Learn more about how you can start doing your life's best work.(sm)
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.
Job Keywords: healthcare, health care, Medicare, Medicare Advantage, Stars, HEDIS, clinical quality, coding, risk adjustment, CRC, CPC, RN, Portland, Biddeford, Maine, ME telecommute, York County, Cumberland County, remote, work from home, telecommuter