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) The Practice Performance Nurse 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 telephonically at home. Must live in South Carolina. Primary Responsibilities:Functioning independently, connect 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:Current, unrestricted RN or LPN license 3+ years of healthcare industry experience 1+ year experience working with HEDIS measures Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills Preferred Qualifications:Bachelor's Degree or higher level of education Knowledge of Medicare guidelines Medicare Star Rating experience (clinical standards of care, preventive health, and Stars measures) Experience in managed care working with network and provider relations / contracting Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models) Knowledge of electronic medical record systems Strong problem-solving skills Strong communication and presentation skills Strong relationship building skills with clinical and non-clinical personnel 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: Practice Performance Consultant, Medicare, Stars, HEDIS, preventative health, risk adjustment, healthcare, provider, liaison, RN, LPN, nurse, telecommute, work at home, SC, Charleston, South Carolina
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.