Clinical Associate Practice Performance Manager - Full-time / Part-time

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Associate Practice Performance Manager 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 clinical 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 for preventative screenings and/or HEDIS gaps in care, 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. This position does not entail any direct member care* nor does any case management occur. (*with the exception of participating in health fairs and/or health screenings where member contact could occur)

This position is for the following areas in California: Sacramento, Santa Rosa, Redding, or Fresno.

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  


• Assist in the review of medical records to highlight Star opportunities for the medical staff


• Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities


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


• May interact with members via telephone; Schedule appointments, Follow-up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed that relate to preventative health screenings or HEDIS gaps in care 


• Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice


• Provides education to members regarding health care needs and available services related to preventative health screenings or HEDIS gaps in care 


• Works to facilitate member compliance with their appointments, screenings, medications and/or action plans to complete open care opportunities/HEDIS gaps in care 


• Identifies barriers for compliance in preventative health screenings or HEDIS gaps in care and communicates with members and providers to formulate action plan to address 


• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps  


• 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


• Provides care coordination through physician practices for members to improve clinical quality and clinical documentation


• 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, 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


• Includes up to 50% local travel 

What are the reasons to consider working for UnitedHealth Group?   Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays


• Medical Plan options along with participation in a Health Spending Account or a Health Saving account


• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage


• 401(k) Savings Plan, Employee Stock Purchase Plan


• Education Reimbursement


• Employee Discounts


• Employee Assistance Program


• Employee Referral Bonus Program


• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)


• More information can be downloaded at: 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Associate's Degree or Higher in Nursing


• Current, unrestricted RN or LVN license in the state of California


• 1+ years of clinical experience in a hospital, acute care, direct care, home health, or case management setting


• 1+ years of experience in STARs    


• 1+years of experience with EMR’s (electronic medical records)


• Reliable transportation with valid driver’s license and proof of insurance to travel to provider offices  


• MS Office proficiency (at least beginner in Outlook, Excel, & PowerPoint) 


• Ability to travel up to 50% within the state  


• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. 

Preferred Qualifications:

• BSN (Bachelor of Science in Nursing) 


• Experience in Consulting


• Experience in Case Management or CCM (Certified Case Manager) 


• Experience in managed care working with network and provider relations/contracting


• Solid knowledge of the Medicare market  


• Knowledge base of clinical standards of care and preventive health 


• Excellent problem solving skills  


• Solid communication and presentation skills  


• Solid relationship building skills with clinical and non-clinical personnel 

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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 Keywords: Clinical Associate, Practice Performance, Manager, Registered Nurse, RN, Hospital, Acute Care, Direct Care, Home Health, Case Management, Sacramento, CA, Fresno, CA, Santa Rosa, CA, Redding, CA Telecommute, Telecommuter , #RPO, #Yellow