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Senior Practice Consultant - Field Based in MN (Twin Cities Metro Area)

Position Description

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

The Practice Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity. Work is primarily performed at physician practices on a daily basis.

If you are located in Minneapolis, St. Paul MN and Surrounding areas, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and incentive programs focused on improving the quality of care for Medicare Advantage Members
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes
  • Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Provider Scorecard) to analyze data and prioritize gap closure, identify trends and drive educational opportunities
  • Conduct chart review quarterly and provide timely feedback to provider to implement change on a go forward basis
  • Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
  • Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), risk adjustment coding practices, and Optum program administration, use of plan tools, reports and systems
  • Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
  • Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
  • Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
  • Includes up to 75% local travel



Required Qualifications:

  • 5+ years of healthcare industry experience
  • 1+ years of provider facing experience
  • Certified Risk Coder(CRC) or Certified Professional Coder(CPC) & willing to get the other within first year of employment if only certified for one.
  • Strong knowledge of Medicare Advantage including Stars and Risk Adjustment
  • Microsoft Office experience including Excel with exceptional analytical and data representation expertise
  • Strong relationship building skills with clinical and non-clinical personnel



Preferred Qualifications:

  • 1+ years of risk adjustment experience
  • Strong communication and presentation skills
  • Strong problem-solving skills
  • Experience working for a health plan and/or within a provider office
  • Registered Nurse
  • Knowledge base of clinical standards of care, preventive health, and Stars measures
  • Experience with network and provider relations/contracting
  • Experience retrieving data from EMRs (electronic medical records)
  • Experience in a coding educator or auditor role



Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's 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: CPC, CRC, AAPC, Risk Adjustment, HEDIS, STARS

Senior Practice Consultant - Field Based in MN (Twin Cities Metro Area)

Minnetonka, MN
Full Time

Published on 05/16/2019