Field-Based Senior Practice Performance Specialist in Pittsburgh, PA 2343061 | Pittsburgh, PA

Field-Based Senior Practice Performance Consultant

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Employees in this position will work on-site or virtually as an extension of the local quality and provider teams by aligning geographical regions, medical centers and/or physician practices that manage a high volume of UHC Medicare & Retirement membership.

As a Senior Practice Performance Consultant, you will be responsible for partnering with practice admin or clinical staff to review medical records and help close HEDIS gaps in care for Medicare members. This position does not entail any direct member care nor does any case management occur.

This is a field-based position based in Pittsburgh, PA and surrounding areas.

Travel expectation is 75% of the time if needed.

Training: 4 weeks of paid virtual training.

Work Schedule: Monday - Friday, 8 hours between 8am - 6pm EST.

If you reside within Pittsburgh PA, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support the practice and our members ensuring that recommended preventative health screenings are completed and HEDIS gaps in care are addressed.
• Functioning independently, virtually meet 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.
• Assist in the review of medical records to highlight Star opportunities for the medical staff.
• Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities.
• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data.
• Track appointments and document information completely and accurately in all currently supported systems in a timely manner.
• Optimize customer satisfaction, positively impact the closing of gaps in care and productivity.
• Interaction with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and/or providers to assist in scheduling appointments, closing gaps in care or chart collection activities.
• Answer inbound calls from members and/or providers regarding appointments.
• Communicate scheduling challenges or trends that may negatively impact quality outcomes.
• Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs.
• Provide ongoing support and education to team members and assist in removing barriers in care.
• Manage time effectively to ensure productivity goals are met.
• Ability to work independently in virtual setting. Ability to solve problems, use best professional judgment and apply critical thinking techniques to resolve issues as they arise.
• Identify and seek out opportunities within one's own workflow to improve call efficiency.
• Adhere to corporate requirements related to industry regulations/responsibilities.
• Maintain confidentiality and adhere to HIPAA requirements.
• Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level.
• Appointment coordination for specialist appointments, late to refill medication outreach and scheduling members for local market clinic events.
• Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts.
• Field based activities require the abilities to support appropriate targeted providers.
• Work internally with support team on ad-hoc projects, initiatives, and sprints to address measure star ratings and increase overall measured performance.
• Participate and engage with team on member or provider campaigns which may include documentation tracking, member outreach, data analysis and data entry.
• Support incentive account owners on strategy development, feedback and participate within monthly meetings to give updates on member outreach or quality measure closures.
• Support EMR data exchange initiatives with incentive program owner to establish data communication between provider group and UHC.
• Other duties, as assigned.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED (or higher)
• 1+ years of experience in healthcare background with medical terminology familiarity of clinical issues
• 1+ years of experience in EMR
• 1+ years of experience with HEDIS knowledge
• 1+ years of working experience with Microsoft Tools: Word, Outlook, and Excel (navigating, filtering and analyzing reports)
• 1+ years of working experience with knowledge of HIPAA compliance requirements
• 6+ months of telephonic customer service experience
• Ability to travel within Pittsburgh, PA and surrounding areas to visit provider offices (expectation is up to 75% of the time)
• Active and unrestricted driver's license in your state of residence

Preferred Qualifications:

• 1+ years of working experience with ICD- 9/10 and CPT Codes
• Experience working in a physician, provider, and/or medical office is preferred
• LPN
• Medical Assistant
• Pharmacy Technician

Soft Skills:

• Strong data entry skills, with a typing speed of at least 45-50 WPM
• Demonstrated ability to identify with a consumer to understand and align with their needs and realities
• Demonstrated ability to perform effective active listening skills to empathize with the customer to develop 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
• Good Attendance Record

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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