Healthcare Advocate, Network Program Consultant, San Diego/Orange County region - Telecommute - 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, Network Program Consultant 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. Network Program Consultants 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:


Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members

Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources

Consult with and Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status

Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals

Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity

Provide training to provider groups on Medicare Advantage, quality measures (HEDIS) and risk adjustment

Coordinate large and small group training sessions in collaboration with the Optum Coding Trainers and Clinical staff

Collaborate with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts

Coordinate risk adjustment chart reviews with capitated or risk share providers

Work with providers to break down barriers for chart review participation

Facilitate and educate providers on RADV, and data validation audits

Maintain an office in the home, and will travel regularly to provider offices
 
 

Required Qualifications:


Undergraduate degree or equivalent relevant work experience

3+ years of network management, pharmaceutical sales, provider data, contracting,  coding, nursing or consulting experience

Ability to develop long term relationships

Good work ethic and ability to work independently

Excellent oral and written communication skills (ability to communicate effectively with various levels of leadership and experience giving group presentations)

Strong business acumen and analytical skills

Proficiency in Microsoft Word, Excel and PowerPoint

Knowledge of Risk Adjustment

Ability to travel within assigned territory (day trips) 30% of the time
Preferred Qualifications:


Knowledge of managed care, HEDIS and Medicare programs

Project management experience
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.


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