For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Clinical Adherence Consultants work directly with health plans to review contractual requirements, gather business requirements and provide guidance on high risk problem prone areas in clinical program delivery and execution. They also provide clinical process expertise; identify impacts to programs & processes, workflows, systems, regulations, compliance, and performance standards. They support the development of required processes, documentation, staffing, and the detailed, understandable communication of program/process changes and status with all stakeholders. Responsibilities are outlined below. Primary Responsibilities: Acts in a consultative and supportive role in the management of process and clinical performance measurements / metrics Effectively executes process steps in a continuous iterative infrastructure that promotes improvement, transparency and member advocacy Communicate clinical adherence requirements, policies and procedures Facilitates clinical process improvement activities Perform qualitative reviews and analysis of clinical processes Assists in designing performance metrics working closely with Complex Care Business Intelligence in the creation of reports and measurements Assists in ensuring local clinical processes / operations, policies and procedures meet standards and are consistent with State and Federal guidelines Other duties as assigned
Required Qualifications: Current and unrestricted RN Licensure in state of New York 3+ years of clinical experience 2+ years of data analysis and / or audit experience within the healthcare industry 2+ years of quality improvement experience or other relevant experience Experience with interpreting contracts and regulatory requirements Experience working with Medicaid and / or Medicare Intermediate level of proficiency in tracking, trending and reporting on metrics Intermediate or better level of proficiency in MS Word, MS Excel, and MS PowerPoint Demonstrated ability to lead and influence in a large, matrix organization Demonstrated ability to communicate ideas clearly and concisely both in verbal and written form Ability to interface with strategic clients; experience with senior leadership level communication and presentation required Excellent time management, organizational and prioritization skills and ability to balance multiple priorities Ability to assess complex problems and recommend appropriate solutions Demonstrated ability to think strategically and to proactively manage implementation of broad - based as well as specific initiativesCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) 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: RN, Nurse, Registered Nurse, Statistical Analyst, Process Analysis, Data Reporting, Quality Improvement, Quality, Adherence, Compliance, Operations, Regulatory, CCM, CMS, Core Measure, URAC, NCQA, UnitedHealthcare, UHG, United Health Group, NY, New York, Telecommute, Telecommuting, Telecommuter, Remote
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.