UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
Do you enjoy working with both providers and members to address care gaps? Become part of our team and build high value relationships with providers in assigned areas to drive member health outcomes. Proactively identify issues that hinders provider relationship with plan. Continuously look for innovative channels to engaging both members and providers at a higher level.
If you are located in Arizona, you will have the flexibility to telecommute* as you take on some tough challenges. This position will also require travel up to 25% of the time in Arizona.
- Support STARS improvement projects, HEDIS, CAHPS measures and provide clinical guidance
- Member outreach to address care gaps
- Identify and implement opportunities to improve rates or efficiency of data collection
- Ensure projects are completed on time and in scope Monitor of reports and weekly playbook
- Support both national and local team efforts
- Educate providers on general policies and procedures applicable to delivery of care
- Educate providers on proper HEDIS documentation/coding for member compliance
- Where possible, engage with providers to introduce new initiatives and monitor success of those in place and to identify issues and ensure effective problem resolution to maintain solid relationships
- Serves as the primary point of contact, consultative resource, and subject matter expert in all aspects of medical record documentation requirements and coding as they apply to CMS Stars/HEDIS measures specifications
- Closely work with internal stakeholders and providers to engage members and close care gaps
- Weekly and monthly productivity reports for outreach
- Support Health Plans as Subject Matter Expert of STARS and HEDIS Technical Specifications, project plans, and reporting logistics
- Need to work independently and within an integrated team in a highly matrixed environment
- Attend weekly/monthly and adhoc Webex/Microsoft Teams meeting with national partners
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.
- Registered Nurse with no restrictions in state required to practice
- Candidate must be based in Arizona
- 2+ years of experience in Medicare, DSNP Lines of business
- 2+ years of experience in Stars, HEDIS measure technical specifications
- 3+ years of experience working in a healthcare environment
- 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
- 3+ years of experience in tracking, working with large data sets and making data-driven analytical decisions
- UnitedHealth Group, Optum, or UnitedHealthcare experience
- Community & State and or Medicare & Retirement experience
- Demonstrated ability to communicate ideas clearly and concisely
- Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
- Prior experience working with providers
- Flexibility and quick adaptation to change
- Demonstrated continuous improvement mindset
- Intermediate or higher level of proficiency with Excel and PowerPoint, including visual representation of quality data and trends, use of basic math and statistics functions
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 at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.