Field- Senior Practice Specialist in Pittsburgh, PA

Field-Based Senior Practice Performance Consultant in Pittsburgh, PA and Surrounding Areas

At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts 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.

This is a field-based position based in Pittsburgh, PA and surrounding areas. Travel expectation is 75% - 100% of the time if needed. This position does not entail any direct member care nor does any case management occur.

• 4 weeks of paid virtual training
• Monday - Friday, 8 hours between 8am - 6pm EST
• Telecommute flexibility if residing within Pittsburgh, PA

• 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
• 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
• 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 problem solve, 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 measure 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…