HEDIS Clinical Practice Performance National


You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that can definitely come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance. The position of Clinical Practice Performance Consultant may include some traveling to physician’s practices. You will also review charts (paper and electronic

  • EMR), look for gaps in care, perform STARs assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. 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 full-time, Monday
  • Friday. Employees are required to work our normal business hours of 8:00am
  • 5:00pm, no nights, weekends, or holidays. _ All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy._ Primary Responsibilities: + Provides care coordination through physician practices for members to improve clinical quality and clinical documentation + 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 + Partner with the practice’s administrative and clinical staff while managing member appointments and data between visits + Create and maintain a professional and supportive relationship with the member, provider, and office staff + Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services + Assists the member to access community, Medicare, family, and other third-party resources as appropriate + Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the appointments, screening or care related to preventative health screenings or HEDIS gaps in care + 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 + Documents member conversations and activities in Optum/UHC programs. No documentation in provider EMRs and/or member charts + Maintains a focus on timely, high-quality customer service + Maintains the confidentiality of all sensitive information 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: + Associates Degree (or higher) OR Nursing Diploma + 3+ years clinical experience in a hospital, acute care, home health, direct care, or case management + Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and Excel Preferred Qualifications: + Bachelor of Science in Nursing + Current, unrestricted RN license in the State the staff member resides in as well as any state member outreach is performed + Experience with HEDIS and EMR (electronic medical records) + Experience with navigating and analyzing reports in Microsoft Excel + Medicaid, Medicare, Managed Care experience + Home care/field-based case management + Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs Telecommuting Requirements: + Required to have a dedicated work area established that is separated from other living areas and provides information privacy + Ability to keep all company sensitive documents secure (if applicable) + Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Soft Skills: + Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action + Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others + Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s) _UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status._ Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make the health system 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 healthcare 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 Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 – $118,300. The salary range for Connecticut / Nevada residents is $72,800 – $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group , you’ll find a far-reaching choice of benefits and incentives. 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….. click apply for full job details

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