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Healthcare Advocate

1 month ago

Hollywood, Florida, United States UnitedHealth Group Full time
Optum Care Specialist

At UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As an Optum Care Specialist, you'll play a critical role in delivering care and improving health outcomes for millions of people.

Key Responsibilities:
  • 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.
  • Utilize data analysis to identify and target providers who would benefit from our coding, documentation, and quality training and resources.
  • Establish positive, long-term relationships with physicians, medical groups, IPAs, and hospitals.
  • Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity.
  • Manage end-to-end Risk and Quality Client Programs.
  • Consult with provider groups on gaps in documentation and coding.
  • Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding.
  • Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership.

Requirements:
  • 2+ years of a healthcare background with medical terminology, familiarity of clinical issues.
  • 1+ years of experience with Hospital or provider office EMR.
  • Intermediate level of knowledge of ICD10, HEDIS or Stars.
  • Intermediate level of proficiency in MS Office Excel, ability to manipulate data, filter.
  • Intermediate level of proficiency in MS Office Word, ability to create, edit, and save documents.
  • Intermediate level of proficiency in MS Office PowerPoint, ability to create and present presentations.
  • Fluent in Spanish & English.
  • Ability to travel up to 75% of the time in the lower Broward County to upper Miami-Dade County regional area.

Preferred Qualifications:
  • Certified Professional Coder / CPC-A; equivalent certifications acceptable.
  • 3+ years of provider network management, physician contracting, healthcare consulting, Medicare Advantage sales, or Pharmaceutical sales experience.
  • 2+ years of clinic or hospital experience and/or managed care experience.
  • 1+ years of coding performed at a healthcare facility.
  • Territory management experience.
  • Experience in Risk Adjustment and HEDIS/Stars.
  • Experience in management position in a physician practice.
  • Project management experience.
  • Knowledge of billing/claims submission and other related actions.
  • Nursing background i.e. LPN, RN, NP.

Why UnitedHealth Group?
At UnitedHealth Group, we believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. 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.