Senior Clinical Practice Performance Specialist

UnitedHealth Group • Toms River, NJ

144d • $23 - $41 • Onsite

About The Position

This position is Field Based and requires regular travel to various locations as part of your daily responsibilities. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm EST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

Requirements

• High School Diploma/GED
• Must be 18 years OR older
• 2+ years of customer service experience
• 1+ years of a healthcare background with medical terminology familiarity
• 1+ years of working experience with and knowledge of HIPAA compliance requirements
• Medical Assistant, Pharmacy Technician, Medication Technician, or Licensed Practical Nurse (LPN) experience
• EMR (Electronic Medical Record) and HEDIS knowledge and experience
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)
• Ability to travel up to 50% of the time
• Reside within an hour from Toms River, New Jersey
• Ability to work full-time Monday - Friday.

Nice To Haves

• Telephonic customer service experience
• Experience working in a physician, provider, and/or medical office
• Medication terminology experience

Responsibilities

• Functioning independently, virtually 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.
• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps.
• Track appointments and document information completely and accurately in all currently supported systems in a timely manner.
• Optimize customer satisfaction, positively impact the closing of gaps in care and productivity.
• Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support the practice and our members ensuring that recommended preventative health screenings are completed and HEDIS gaps in care are addressed.
• Interaction with UHC members via telephone to assist and support an appropriate level of care.
• Answer inbound calls from members and/or providers regarding appointments.
• Communicate scheduling challenges or trends that may negatively impact quality outcomes.
• Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs.
• Provide ongoing support and education to team members and assist in removing barriers in care.
• Manage time effectively to ensure productivity goals are met.
• Ability to work independently in virtual setting.
• Ability to problem solve, use best professional judgment, and apply critical thinking techniques to resolve issues as they arise.
• Identify and seek out opportunities within one's own workflow to improve call efficiency.
• Adhere to corporate requirements related to industry regulations/responsibilities.
• Maintain confidentiality and adhere to HIPAA requirements.
• Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level.
• Appointment coordination for specialist appointments, late to refill medication outreach and scheduling members for local market clinic events.
• Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts.
• Field based activities require the abilities to support appropriate targeted providers.
• Work internally with support team on ad-hoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance.
• Participate and engage with team on member or provider campaigns which may include documentation tracking, member outreach, data analysis and data entry.
• Support incentive account owners on strategy development, feedback and participate within monthly meetings to give updates on member outreach or quality measure closures.
• Support EMR data exchange initiatives with incentive program owner to establish data communication between provider group and UHC.
• Other duties, as assigned.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED