RN Chart Auditor - Nashville, Franklin or Brentwood, TN - Full-time / Part-time

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)
 
This position will be a telecommuter role in the Nashville, Franklin and Brentwood, TN region. You will be responsible to review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. This position is Monday - Friday during business hours. 
 
Primary Responsibilities:

Provides care coordination / case management through physician practices for members to improve clinical quality and clinical documentation - No direct patient care
Conducts telephonic member outreach for needs assessments according to state and national guidelines, policies, procedures and protocols
Interacts with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed
Review member charts prior to a physician appointment and create alerts / triggers to highlight Star opportunities for the practice
Partner with the practice's administrative and clinical staff while managing patient appointments and data between visits
Create and maintain a professional and supportive relationship with the patient, provider and office staff  
Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services
Assists the member to access community, Medicare, family and other third-party resources as appropriate
Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
Provides education to members regarding health care needs and available services
Works to facilitate member compliance with their care / treatment plan and to ensure continuity of care
Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address
Documents all care coordination activities and interventions in the member’s health plan clinical record
Maintains a focus on timely, high-quality customer service
Maintains the confidentiality of all sensitive information

Required Qualifications:


Current, unrestricted RN license in the State
3+ years of clinical experience as a Registered Nurse in a hospital, acute care, home health, direct care or case management
Experience reviewing charts to identify gaps in care
Computer / typing proficiency to enter / retrieve data in electronic clinical records/medical records (EMRs); experience with email, Internet research, use of online calendars and other software applications. Intermediate proficiency with MS Office and Excel
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Must be able to travel to provider offices within service area, may require up to 1 hour radius for travel, from the assigned UHC or Optum facility
Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities
Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect
Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s)
Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
An area designated in your home that is distraction free to utilize as a home office
Access to high speed internet via DSL/cable
Preferred Qualifications:

Bachelors of Science in Nursing
Case Management experience including Certification in Case Management
Experience with Medicare Star Rating System Quality Measures
Experience with HEDIS
Experience with navigating and analyzing reports in Microsoft Excel
Medicaid, Medicare, Managed Care experience
Prior Physician Office experience
Home care / field based case management
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
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)
 
 
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 drug test before beginning employment.
 
 
Job Keywords:  RN, Registered Nurse, Case Manager, Nursing, HEDIS, EMR, Star Rating System, STARS, Managed Care, Medicare, Nashville, Franklin, Brentwood, TN
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