Practice Performance Consultant RN - Remote | WFH

Primary Responsibilities

Conduct telephonic member needs assessments following state and national guidelines, policies, procedures, and protocols.

Interact with patients via telephone to schedule appointments, conduct follow-up calls to ensure understanding of services, answer questions, and confirm completion of necessary procedures.

Provide care coordination and case management through physician practices to enhance clinical quality and documentation; no direct patient care involved.

Review member charts before physician appointments, identifying opportunities to enhance Star ratings for the practice.

Collaborate with administrative and clinical staff of the practice to manage patient appointments and data between visits.

Establish and maintain professional and supportive relationships with patients, providers, and office staff.

Facilitate appropriate member referrals to specialized programs such as Behavioral Health, Advanced Illness, and Social Services.

Assist members in accessing community, Medicare, family, and third-party resources as needed.

Coordinate care needs for members with interdisciplinary teams and communicate effectively with healthcare providers and service delivery teams.

Educate members on healthcare needs and available services.

Promote member compliance with care and treatment plans to ensure continuity of care.

Identify barriers to optimal care and outcomes, collaborating with members and providers to develop action plans.

Document all care coordination activities and interventions in the member's health plan clinical record.

Focus on delivering timely, high-quality customer service while maintaining confidentiality of sensitive information.

You'll Be Rewarded And Recognized For

Your performance in a challenging environment that provides clear direction for success in your role and opportunities for professional development.

Required Qualifications

Current, unrestricted RN license in the State of Delaware.

3+ years of clinical experience in hospital, acute care, home health, direct care, or case management settings.

Intermediate proficiency in electronic clinical records and MS Office products (Word, Excel, PowerPoint).

Ability to travel to provider offices within the service area approximately 25% of the time as required by business needs.

Valid and unrestricted driver's license, proof of insurance, and ability to travel to provider offices or other locations within the service delivery area.

Preferred Qualifications

Bachelor of Science in Nursing.

Case management experience, including Certification in Case Management.

Experience with HEDIS and electronic medical records (EMR).

Experience in Medicaid, Medicare, Managed Care, physician office settings, home care, intensive care (ICU), emergency department (ER), or with vulnerable populations.

Experience navigating and analyzing reports in Microsoft Excel.

Soft Skills

Strong problem-solving skills; ability to analyze problems, draw conclusions, and devise appropriate courses of action.

Excellent verbal and written communication skills; ability to convey complex information clearly and understand technical information.

Ability to empathize and align with customer needs, demonstrated through effective active listening skills.

Proven initiative and goal orientation, going above and beyond to meet customer needs.

Adherence to UnitedHealth Group's Telecommuter Policy for remote work.

Employment Type: Full-Time