Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.(sm)
This role is responsible for provider performance management of our Dual Eligible members (DSNP) in the Optum at Home program 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, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.
Schedule: Monday-Friday, 8AM - 5PM
If you reside in West Des Moines, IA or surrounding communities, you'll enjoy the flexibility of a field-based hybrid-remote role as you take on some tough challenges.
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
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.
Associate's Degree (or higher) in Nursing
Current, unrestricted RN license in the state of Iowa
3+ years of clinical experience in a hospital, acute care, home health, direct care, or case management
Intermediate level of proficiency with entering and retrieving data in electronic clinical records, email, internet research, use of online calendars and other software applications including MS Office and Excel
Access to reliable transportation, a valid and unrestricted driver’s license, and proof of insurance
Ability to travel to provider offices or other locations within service delivery area, with up to a 2-hour radius for travel
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
Bachelor of Science Degree in Nursing
Case management experience, including Certification in Case Management
Experience with HEDIS and EMR (electronic medical records)
Experience with navigating and analyzing reports in Microsoft Excel
Medicaid, Medicare, Managed Care experience
Prior physician office experience
Home care/field-based case management
Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Call center experience
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
Must be able to travel to provider offices within service area – may require up to 1-hour radius for travel
Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities
Demonstrated ability to perform effective active listening skills to empathize with the customer to develop a trust and respect
Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done to achieve a goal(s)
Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
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 with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.