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

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

Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on STARs and HEDIS through analysis of data and reporting. Effective communication is a must. This role relies on the ability to work effectively with internal and external relations as well as UHC members in order to drive success and outcomes.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm.

Primary Responsibilities:

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  Support quality improvement efforts using data analytics, technology, innovative workflows and effective communication.
  


• Data analysis required from multiple IT system platforms to identify opportunities to address quality gaps on a member or provider level.
  


• Participate and engage with team on member and provider campaigns which include documentation tracking, member outreach, data analysis, data entry and data delivery.
  


• Interaction with UHC members via telephone to assist and support an appropriate level of care. This includes making outbound calls to members and/or providers to assist in closing gaps in care, chart collection activities, or scheduling appointments.
  


• Conduct ‘late to refill’ medication outreach using all available channels.
  


• Answer inbound calls from members and/or providers.
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  Demonstrate sensitivity to issues and show proactive behavior in addressing customer/client and member needs.
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  Communicate issues and barriers to leadership for resolution.
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  Provide ongoing support and assist in removing barriers.
  


• Document information completely and accurately in a timely manner.
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  Manage time effectively to ensure goals are met.
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  Optimize customer satisfaction, positively impact gap closure and drive productivity.
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  Function independently; virtually meet with provider groups to discuss performance, and education resources.
  


• Ability to problem solve, use professional judgment and critical thinking techniques to resolve issues as they arise.
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  Identify and seek out opportunities within one’s own workflow to improve efficiency.
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  Adhere to corporate requirements related to industry regulations/responsibilities.
  


• Maintain confidentiality and adhere to HIPAA requirements.
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  Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts.
  


• Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support Provider practices and our members.
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  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 measure performance
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  Assist in the review of medical records to highlight Star opportunities.
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  Support incentive account owners on strategy development, feedback and participate within monthly meetings to give updates on member outreach status and gap closure.
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  Support EMR access and data exchange initiatives with incentive program owner to establish data communication between provider group and UHC
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  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.
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  Other duties, as assigned.

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:

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  High School Diploma / GED (or higher)
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  5+ years of telephonic customer service experience
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  3+ years of a healthcare background with familiarity of clinical workflows
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  3+ years of working experience with Microsoft Tools: Excel
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  3+ years of working experience with and knowledge of HIPAA compliance requirements
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  Ability to travel up to 75% of the time
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  Ability to work our normal business hours of 8:00am to 5:00pm, Monday - Friday
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  Reside within 50 miles of Columbus, OH

Preferred Qualifications:

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  LPN, Certified Pharmacy Technician or other clinical specialist
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  Experience working in a hospital or health-system
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  Knowledge of EHR clinical workflows
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  Medicare knowledge and experience

Soft Skills:

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  Strong data analysis and data interpretation skills
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  Effective communication of complex subject matter and materials
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  Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect
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  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)
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  Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
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  Good Attendance Record
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  Problem solver
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  Analytically minded

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM

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.

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