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RN Medical Management Consultant - San Jose and San Francisco, CA Areas

UnitedHealth Group

San Jose, CA
Job Code:
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Job Details

RN Medical Management Consultant - San Jose and San Francisco, CA Areas(Job Number:707130)

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
Primary Responsibilities:
  • Monitors monthly and quarterly UM performance of assigned medical groups: conducts analysis of UM data and interprets results to assess the performance of the group; identifies strategies for improvement to include specific outcomes and metrics to monitor progress to a goal; provides feedback and makes recommendations in coordination with the Medical Director to Medical groups/Accountable Care Organizations
  • Conducts analysis of group and affiliated network contracts, local market data, and other utilization data to develop strategies for improvement; collaborates with assigned Medical Director to develop strategic initiatives for the Medical Group; presents findings at JOC meetings and in Medical Management meetings to the Group’s Medical Director and other clinical leaders; completes analysis of information focused on assigned region and is always current on regional market
  • Lead multi-disciplined practice transformation and practice performance improvement initiatives. He/she will guide practices in achieving targeted goals that include improved quality, efficiency and utilization
  • Provides training to medical groups and hospitals on a variety of topics
  • Participates in medical group and hospital orientation and conversion activities
  • Acts as an internal consultant to develop, implement and maintain new and revised medical management systems and business processes Acts as primary contact for the Medical Group to resolve general clinical and operational issues; attends regular internal meetings with Network Management and Sales staff
  • Attends and presents at external meetings such as the JOC, Orientations, Medical Group Training classes, PMG/IPA ACO and Hospital Utilization Management meetings
  • Assists other internal departments with Medical Group conversions and terminations
  • Travel is frequent, up to 25% of the month; typically, same day trips to Medical Groups Occasional overnight trips to the regional office and to outlying medical groups
  • Establishes and maintains strong working relationships with key internal and external constituencies
  • Using results of practice readiness assessments and other collected information, design practice transformation action plans and implement appropriate performance improvement initiatives designed to assist the practice in achieving contractually required transformation milestones. Monitor and review the progress of the practice in milestone achievement and insure the practice is accountable for successful completion
  • Regularly facilitate efficient, effective practice improvement meetings with the practice to monitor, present, and discuss progress on the transformation action plan and achievement in milestones

Job Medical Mgmt Ana & Consulting
Primary Location US-CA-San Jose
Other Location US-CA-San Mateo, US-CA-SANTA CRUZ, US-CA-San Francisco
Organization Bus Standardization & Advance
Schedule Full-time
Number of Openings 1
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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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