HEDIS Practice Performance RN - Albany, GA

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)
 
The Practice Performance Coordinator is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 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), look for gaps in care, perform telephonic assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Work is primarily performed at physician practices on a daily basis.
 
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

Execute applicable provider incentive programs for health plan

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

Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes

Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution

Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation

Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems

Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals

Provide reporting to health plan leadership on progress of overall performance, HQPAFs, gap closure, and use of virtual administrative resource

Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation

Provide suggestions and feedback to Optum and health plan

Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps

Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient care

May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols

May interact 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

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

Collaboration with the Asian Initiative Team

Includes up to 75% local travel
 

Required Qualifications:



Current, unrestricted RN license in the State of residence

3+ years of healthcare industry experience

3+ years of experience as a Registered Nurse

Strong communication and presentation skills

Strong relationship building skills with clinical and non-clinical personnel

Strong problem-solving skills

Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills

Experience retrieving data from EMRs (electronic medical records)
Preferred Qualifications:


Strong knowledge of the Medicare market

Experience working for a health plan and/or within a provider office

Case Management experience including Certification in Case Management

Knowledge base of clinical standards of care, preventive health, and Stars measures

Experience with HEDIS Quality Measures

Experience with CMS Quality Measures

Experience in managed care

Experience with network and provider relations/contracting

Experience with navigating and analyzing reports in Microsoft Excel

Medicaid, Medicare, Managed Care experience

Prior Physician Office experience
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.
 
 
Job Keywords:  RN, Registered Nurse, Case Manager, Nursing, HEDIS, EMR, Managed Care, Medicare, Albany, Georgia, GA