Healthcare Advocate - Raleigh, NC - Full-time / Part-time

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Healthcare Advocate is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program/product implementation. This includes enterprise-wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness.

Healthcare Advocates may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

Primary Responsibilities:

• Anticipate customer needs and proactively develop solutions to meet them
  
• Serve as a key resource on complex and/or critical issues
  
• Solve complex problems and develop innovative solutions
  
• Perform complex conceptual analyses
  
• Review work performed by others and provide recommendations for improvement
  
• Forecast and plan resource requirements
  
• Authorize deviations from standards
  
• May lead functional or segment teams or projects
  
• Provide explanations and information to others on the most complex issues
  
• Motivate and inspire other team members
  
• Utilize data analysis, identify and target providers who would benefit from our Medicare Risk Adjustment training and documentation/coding resources
  
• Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
  
• Reach out to physicians, medical groups, IPAs and hospitals, to build positive, long-term, consultative relationships
  
• Develop comprehensive, provider-specific plans to increase their RAF performance
  
• Train providers on our Risk Adjustment programs and tools, and work toward the adoption of these programs in to their practices. Position will also be responsible for educating providers on Medicare STARs ratings as well as promoting member Hedis quality screenings
  
• Collaborate with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts

This role will function independently, traveling in the Raleigh, NC area to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members.

Required Qualifications:

• 1+ years of experience as a Nurse, clinical coder or experience with healthcare quality initiatives (STARs/HEDIS/PQRS)


• Intermediate knowledge of Managed Care or Medicare programs


• 1+ years of experience giving group presentations


• Intermediate proficiency in MS Word, Excel and PowerPoint


• Must be able to travel 50%


• 1+ years of experience in network management, contracting, sales or consulting Pharmaceutical Sales Experience

Preferred Qualifications:

• Undergraduate degree

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: 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.