Field Clinical Practice Consultant RN - Multiple Counties in Texas

At UnitedHealthcare, 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 position is responsible for ongoing HEDIS collection and improvement activities at the health plan and reports to the Quality Management Leader.

If you reside near Bexar, Kendall, Bandera, Medina Atascosa, Wilson, Guadalupe, Comal, Counties, TX, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

This position will require travel up to 75% of the time to providers offices.

Primary Responsibilities:

• Coordinates and performs onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards and where assigned investigation of quality of care and member complaints relative to quality of care and service
• Support continuum of member care by identifying members in need of health education, case management, etc
• Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria
• Solicit identification of barriers the office faces in providing care to members
• Supports the HEDIS medical record chase to support optimum HEDIS and quality metric reporting
• Supports quality improvement program studies requesting records from providers, maintaining databases and researching to identify members' provider encounter history
• Participates in and represents plan at community, health department, collaborative and other organizational meetings focusing on quality improvement, member education and disparity programs, as assigned
• Performs annual medical record evaluation, follow-up education, practitioner intervention, measurement (QI 13) as required
• Enter documentation of findings in identified database
• Generally works independently, under the supervision of the Quality Management leader
• Participates in or coordinates with other department projects as needed
  

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

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:

• Current unrestricted RN licensure in Texas
• 5+ years of clinical experience in any setting
• 2+ years of quality improvement experience (chart review, compliance, HEDIS, investigation, utilization review, etc.)
• 2+ years of experience reviewing and evaluating medical records with attention to detail
• 2+ years of aexperience working in Medicaid/Medicare health care and insurance industry, including regulatory and compliance requirements
• Intermediate level of proficiency in software applications that include, Microsoft Word, Excel, Microsoft Outlook
• Ability to make formal presentations in front of committee and work group environments
  
• Access to reliable transportation that will enable you to travel to client or patient sites within a designated area & valid US driver's license

Preferred Qualifications:

• Bachelor's degree
• Experience in complex populations
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements and the managed care industry
• Bilingual - English / Spanish
• Ability to interact with medical staff, peers and internal company staff at all levels

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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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