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Clinical Health Care Specialist

2 months ago

Floresville, Texas, United States Optum Full time
Job Summary

We are seeking a highly skilled and experienced Clinical Health Care Specialist to join our team at Optum. As a key member of our mobile unit, you will be responsible for conducting healthcare screenings and providing exceptional customer service to our patients.

Key Responsibilities:
  • Perform a variety of healthcare screening activities to assist providers in conducting quality clinics, including administering injections, diagnostic testing, phlebotomy, and quality surveys.
  • Deliver exceptional customer service and maintain established quality control standards.
  • Work directly with our contracted providers to improve their quality goals and provide education and training while onsite at the PCP clinic.
  • Offer guidance and support to the PCP and staff to ensure they have the tools and resources to meet their quality healthcare goals.
  • Travel with the mobile team to clinics and centralized locations to conduct screening clinics to support contracted physician networks.
  • Focus on medication adherence and work with office and patients to ensure patients are able to obtain medications and take them according to prescriber information.
  • Record resolutions of med adherence and other quality indicators that have an action plan and follow through with physician and/or mobile team provider.
  • Follow all physician office guidelines while conducting screening clinics onsite at contracted physician clinics.
  • Arrive to all clinics at least 15 minutes early to introduce the team to the office staff and set up equipment in exam rooms designated for clinic.
  • Organize onsite clinics to ensure all equipment and supplies are on hand and set up in the exam rooms prior to receiving patients for screening appointments.
  • Perform and complete all quality program health screenings per required metrics.
  • Process appropriate documents in an organized and accurate manner and copy all physician on patient results and quality forms submitted.
  • Review all patient screening forms to ensure outstanding healthcare screenings are performed.
  • Record patient care documentation in the medical records accurately and according to company policy.
  • Conduct post-audits on all information submitted to quality program to make sure information was complete and presented within guidelines.
  • Review all medical information, test results, and survey questions prior to the patient leaving to ensure all information is captured.
  • Presents abnormal results to the provider promptly to ensure there is not an emergent condition that needs immediate attention.
  • Post-clinic preparation of mobile team charts for faxing, filing, and forwarding to the PCP offices.
  • Compile results and enter information into utilization reports for submission to management.
  • Support contracted physician group by providing training and education to the office staff in ePRG, use of equipment, and process to accurately complete quality forms sent by the PCP.
  • Work collaboratively with mobile team staff, medical director, PBMs, and provider offices to ensure completion of quality forms and improve overall quality score.
  • Float to assigned positions/locations as needed to support and assist with patient screening overflows, high-volume clinics, and staff absences.
  • Maintain confidentiality of all materials handled within the department as well as proper release of patient information at all times.
  • Maintain licensures/certifications (LVN and BLS) and quality control standards.
  • Participate in marketing events as determined by business need.
  • Perform all other related duties as assigned.
Requirements:
  • High school graduate or GED equivalent.
  • Current unrestricted Vocational Nurse License in applicable state.
  • Current BLS certification for healthcare providers (written exam and in-person assessment) at time of hire or within 30 days of hire.
  • Valid drivers license within the state of work.
  • 1+ years of related LVN experience in a clinical setting.
  • Basic computer literacy.
  • Knowledge of medical terminology.
  • ICD-10 and CPT coding.
  • Proven ability to react calmly and effectively in emergency situations.
  • Proven independent problem identification resolution and decision-making skills.
  • Proven excellent communication and customer service skills.
  • Proven ability to travel frequently within assigned market.
  • Proven flexible and adaptable to change.
  • Reliable transportation for daily travel to various locations/clinics as assigned.
Preferred Qualifications:
  • 3+ years of LVN experience in a clinical setting.
  • Successful demonstration as a LVN in physician office with skills to teach, lead, and educate staff; understand the compliance of all quality procedures and clinical guidelines of the company clinic policies.
  • HEDIS or Quality Audit experience.
  • Bilingual (English/Spanish).