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Practice Performance Consultant (RN) - Rogersville or Elizabethton, TN

01/24/2018Call Center
Job Location:
Rogersville, TN
Metro Area:
TN - Tri-Cities
Company Name: UnitedHealth Group
Website:  Click to Visit
UnitedHealth Group
This is a field based position traveling to physician practices. Case managers review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention.Case managers primarily work at physician practices on a daily basis. If you are located within a commutable distance to either Rogersville or Elizabethton, Tennessee, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient care. May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols May interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed . 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 patient appointments and data between visits. Create and maintain a professional and supportive relationship with the patient, 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 members health care and service with our interdisciplinary delivery team to coordinate the care needs for the member Provides education to members regarding health care needs and available services Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address Documents all care coordination activities and interventions in the members health plan clinical record Maintains a focus on timely, high-quality customer service Maintains the confidentiality of all sensitive information


Required Qualifications: Active, unrestricted RN license in the state of Tennessee 3+ years of clinical experience in a hospital, acute care, home health, direct care or case management Reliable transportation and the ability to travel to provider offices or other locations within service delivery area Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and Excel Preferred Qualifications: Bachelors of Science 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 Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action 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 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 in order to develop a trust and respect 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) Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer Make a difference in countless lives, starting with your own. Join us and start doing your lifes best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy. 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. Job Keywords: Nurse, RN, registered nurse, Practice Performance Consultant, Medicare, Stars, HEDIS, preventative health, risk adjustment, healthcare, provider, liaison, Elizabethton, Rogersville, TN, Tennessee
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