Practice Performance Consultant -Registered Nurse Preferred - Beloit / Janesville, WI areas (Field-based) - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
 
This is an embedded role. Will work in the EMR entering labs, and orders. Will also work closely with the physicians to review suspect conditions and appropriate documentation/coding. Member outreach with clinical discussion regarding member's clinical needs and screenings as well as post visit follow up and referral to additional programs internally as well externally. The Practice Performance Consultant 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.
The expectation is that 5 days a week is spent in provider’s offices. In addition, must be flexible and willing to travel (daytime hours) within a couple hour radius of their home once or twice a week to various provider locations in the  Southeastern part of WI –  Walworth County area to Kenosha, Beloit and Janesville area.
 
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

Required Qualifications:

Bachelor’s Degree required or equivalent work experience
3+ years of healthcare industry experience
Knowledge of Medicare market  
Strong communication and presentation skills
Strong relationship building skills with clinical and non - clinical personnel
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
Preferred Qualifications:

Medicare Star Rating experience
Registered Nurse License
Experience working for a health plan and/or for a provider's office
Medical / clinical background highly
Strong knowledge of electronic medical record systems
Consulting experience
Strong knowledge of the Medicare market
Knowledge base of clinical standards of care, preventive health, and Stars measures
Experience in managed care working with network and provider relations / contracting
Strong problem - solving skills
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
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 Keyword: Practice Performance Consultant, HEDIS, STARS, Medicare, RN, Registered Nurse, Walworth County, Kenosha, Beloit, Janesville, WI, Wisconsin