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) When you use your skills, talent and energy for the members of UnitedHealthcare, you'll be able to do more and do it better. If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care in the Medicare and Retirement population that we serve. We contract with states and other government agencies to provide care for these individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach. By tapping into our extensive knowledge base to manage care plans for retirees, elderly, disabled, and chronically ill people, you'll ensure that their unique needs are fully understood by all care givers. In short, you'll help make a huge health care system work like a personalized health care team. This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. This team is comprised of individuals with the tenacity and the dedication to make things work better for millions of people all over our country. Position Description:The United Retiree Solutions (URS) Clinical & Quality Team is responsible for ensuring our Group Medicare Advantage members live healthier Lives by receiving the right care, at the right time, and at the right place. We support the largest group Medicare Advantage plan in the nation. This clinical position is located in Connecticut, Virginia, or Pennsylvania and is responsible for the clinical account management including strategic planning in relation to plan medical performance, consultative services, recommendations for benefit design, closing gaps in care, improving clinical outcomes and identifying medical expense management opportunities. This position interfaces with enterprise-wide clinical staff working serving this account. The position works closely with local UHG market teams to research, develop and present new or existing strategies to improve quality / Star rating performance, reduce inappropriate medical spend, ensure accurate documentation of members conditions and increase Net Promoter Scores. This position reports directly to the URS Vice President of Clinical Quality and indirectly to the URS Director of Clinical Development, Public Sector and Labor. Primary Responsibilities: Provides day to day clinical account management support for assigned employer group account(s) For assigned employer group account(s) is the liaison to the URS Client Management Team and the employer group account(s) for improving Star ratings, risk adjustment accuracy and medical cost reduction opportunities Provides real time data informatics and clinical support to the Medical Director(s) for assigned employer group account(s) Build strong relationships and partner with local market teams and internal clinical teams (Optum, HouseCalls, UnitedHealth Network, United Clinical Services UHC Medicare and Retirement and UHC Employer and Individual) to drive successful outcomes and improvement opportunities Educate and partner with market teams on specific needs for URS business priorities Participate in UHG market meetings to represent URS needs and look for opportunities to leverage or expand local market initiatives Create monthly report highlighting employer group account specific performance and state performance; highlight recommendations for performance improvement and ensure initiatives are in place to achieve goals Negotiate priority initiatives and strategies with senior business leader for the assigned state(s) and employer group(s) Ensure all Star related activities within CT, VA, or PA are achieving the desired 4+ star results 25-50% travel
Required Qualifications:Must reside in the state of CT VA or PA Licensed Registered Nurse or clinical degree required Strong knowledge of Medicare Advantage Star Ratings required 5+ years of experience within the health care industry required 5+ years of interpreting complex data and making strategic recommendations required 3+ years of client management experience required 5+ years of experience driving quantifiable operational improvements required Strong knowledge of documentation and coding / risk adjustment accuracy Care Management expertise Medicare expertise Geriatrics expertise Project / program management experience Proficient with MS Outlook, Word, PowerPoint and advanced Excel skills Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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. Keywords: Connecticut, Virginia, Pennsylvania, PEEHIP, Registered Nurse, Medicare, STARS
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.