Clinical Practice Performance Consultant - Field Based in Orlando, FL

Field Based Clinical Practice Performance Consultant in Orlando, FL

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 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. This position does not entail any direct member care
* nor does any case management occur. (
* except for participating in health fairs and/or health screenings where member contact could occur)

This is a field-based position based in Orlando, FL

Travel expectation is 75% - 100% of the time

4 weeks of paid virtual training

Monday - Friday, 8 hours between 8am - 6pm EST

If you reside in Orlando, FL, you'll enjoy the flexibility to telecommute
* as you take on some tough challenges.

• 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 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 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
• 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.

• High School Diploma/GED (or higher)
• 2+ years of telephonic customer service experience
• 1+ years of healthcare background with medical terminology familiarity of clinical issues
• 1+ years of working experience and knowledge of HIPAA compliance requirements
• Intermediate level of proficiency with Microsoft Office Tools:
  Word, Outlook, Teams, & Excel (navigating, filtering and analyzing reports)
• Ability to travel up to 75% - 100% of the time in the Orlando, FL area
• Access to reliable transportation & valid US driver's license

• Experience working in a physician, provider and/or medical office
• Medical Assistant
• LPN
• EMR and HEDIS knowledge and experience
• Knowledge of ICD- 9/10 and CPT Codes

• 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…