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Healthcare Advocate - Telecommute within Northern CA

UnitedHealth Group


Location:
Santa Ana, CA
Date:
04/21/2017
Job Code:
1734744
Apply on the Company Site
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Job Details


Healthcare Advocate - Telecommute within Northern CA(Job Number:708958)
Description

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

 

The Healthcare Advocate, Network Program Consultant is responsible for the successful program design, compliance with network requirements, network assessment and selection, and program / product implementation. This includes enterprise - wide Clinically Integrated Network teams that focus on specific clinical area Lines of Service (e.g., Cardiology, Women's Health, Oncology, etc.) to improve the quality and affordability through improvements in appropriateness and effectiveness. Network Program Consultants may perform network analysis and strategy development and implementation; obtain data, verify validity of data, and analyze data as required, and analyze network availability and access. Other responsibilities may also include making recommendations regarding use, expansion, selection of networks for various products based on that analysis.

 

Primary Responsibilities:

  • Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
  • Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
  • Consult with and Educate providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
  • Develop comprehensive, provider - specific plans to increase their RAF performance and improve their coding specificity
  • Provide training to provider groups on Medicare Advantage, quality measures (HEDIS) and risk adjustment
  • Coordinate large and small group training sessions in collaboration with the Optum Coding Trainers and Clinical staff
  • Collaborate with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts
  • Coordinate risk adjustment chart reviews with capitated or risk share providers
  • Work with providers to break down barriers for chart review participation
  • Facilitate and educate providers on RADV, and data validation audits
  • Maintain an office in the home, and will travel regularly to provider offices

Job Network Program Mgmt
Primary Location US-CA-Santa Ana
Other Location US-California
Organization RQNS Ops
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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