28 days old

Clinical Practice Performance Consultant (RN)- Gainesville, FL - 937476

Gainesville, FL 32601
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  • Job Code
    937476

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doingyour life's best work.(sm)

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This is a field-based position traveling to physician practices. Case managers review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Case managers primarily work at physician practices on a daily basis.

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Primary Responsibilities:

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  • Conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
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  • Interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed
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  • Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation; no direct patient care
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  • Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice
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  • Partner with the practice's administrative and clinical staff while managing patient appointments and data between visits
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  • Create and maintain a professional and supportive relationship with the patient, provider and office staff
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  • Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services
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  • Assists the member to access community, Medicare, family and other third-party resources as appropriate
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  • Collaborates and communicates with the members health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
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  • Provides education to members regarding health care needs and available services
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  • Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care
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  • Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address
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  • Documents all care coordination activities and interventions in the members health plan clinical record
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  • Maintains a focus on timely, high-quality customer service
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  • Maintains the confidentiality of all sensitive information
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Youll 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.

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Required Qualifications

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  • Current, unrestricted RN license in the State of residence
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  • 3+ years of clinical experience in a hospital, acute care, home health, direct care or case management
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  • 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
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  • Reliable transportation and the ability to travel to provider offices within service area - may require up to 1 hour radius for travel
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  • You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Bachelor of Science in Nursing
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  • Certification in Case Management
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  • Case Management experience
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  • Experience with HEDIS and EMR (electronic medical records)
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  • Experience with navigating and analyzing reports in Microsoft Excel
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  • Medicaid, Medicare, Managed Care experience
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  • Physician Office experience
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  • Home care / field-based case management
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  • Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
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  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
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  • Call Center experience
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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 doyour life's best work.(sm)

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords:RN, Field Based, Practice Performance, Gainesville, FL, Florida

Posted: 2021-06-26 Expires: 2021-08-09

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Clinical Practice Performance Consultant (RN)- Gainesville, FL - 937476

UnitedHealth Group
Gainesville, FL 32601

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