Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

RN Medical Management Consultant - Southern CA

Expired Job

Unitedhealth Group Inc. Fresno , CA 93707

Posted 7 months ago

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)

Act as a consultant between the health plan and the delegates, using information from statistical analysis, and other sources to affect increased efficiency and effectiveness in clinical delegation activities as defined by the applicable delegation agreement. This position has five key objectives:

  • Systemically or at member level, support delegate activities designed to improve clinical outcomes in an efficient and effective manner

  • Consult in the development and monitoring of targeted programs and strategies designed to achieve appropriate utilization and quality goals across the care continuum

  • Consult with the delegate and UHC partners to identify and implement strategies to optimize affordability and quality priorities to improve population health

  • Collaborate with UHC partners to implement improvement strategies to simplify and streamline processes

  • Consult with the delegate regarding systemic, or specific member level process improvement activities in the management of catastrophic, disease and population health management and escalate to UHG partners for resolution (e.g. UHN, Optum, NICM)

This position may report to the Director, Medical Management Clinical Operations or the Vice President, Medical Management Clinical Operations, or Chief Medical Officer of market.

Primary Responsibilities:

  • Monitors monthly and quarterly UM performance and quarterly quality performance of assigned delegates

  • Analyzes data and interprets results to assess the performance of the delegate to ensure alignment with utilization and quality goals of the business

  • Contributes to Quality Team strategies to improve HEDIS, STARs, and other quality metrics

  • Contributes to identifying and implementing Affordability strategies to address market adverse trends

  • Identifies internal and delegate strategies for improvement including the identification of specific outcomes and metrics to monitor progress to a goal

  • Provides feedback and makes recommendations about process improvement, in coordination with

the Chief Medical Officer, to clinical delegates; presents to delegate workgroups, delegates, and leadership

  • Provides consulting to clinical delegates on a variety of topics including utilization management, case management, disease management programs, and operational processes, including sharing best practices

  • As necessary, oversights and follows clinical delegates on potential long stay, or catastrophic inpatient case management cases and advises Chief Medical Officer if inefficiencies are identified. Appropriately documents clinical records within UHC medical management systems as needed.

  • Acts as the liaison for clinical issues related to performance of delegated responsibilities

  • Has knowledge of delegation agreements, local market data, and other data utilized to develop strategies for process improvement

  • As necessary, collaborates with UHC clinical teams to act as a subject matter expert in the development of delegate process improvement initiatives including determining the root cause of issues, proposing solutions, and overseeing recommended changes

  • Presents findings at Joint Operating Committee (JOC) meetings and in Medical Management meetings to the delegate's Medical Directorship and other clinical leaders

  • Attends and contributes in regular internal meetings with Clinical, Quality, Health Plan, Network Management, Sales and other staff, as appropriate

  • Establishes and maintains strong working relationships with key internal and external constituencies

Required Qualifications:

  • Current Registered Nurse license as required by applicable state licensure board

  • A minimum of 5 plus years of relevant work experience in the Medical Group/IPA or Health Plan setting for concurrent review, prior authorizations, case management, referral management, retrospective review and discharge planning in hospital, ambulatory and ancillary settings.

  • Strong clinical program development and program management skills, including

  • Proven ability to identify operational process gaps and clinical gaps in care

  • Demonstrated knowledge of root cause analysis and solution development

  • The ability to gain acceptance from others of a need, plan or idea to achieve a mutually beneficial outcome

  • Proficiency in ICD-CM, CPT, DRG and HCPCS coding

  • Advanced proficiency with Microsoft Excel, Word, and Access

  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as the ability to understand and interpret complex information from others

  • Demonstrated ability to present to and/or train large groups. Advanced proficiency in industry knowledge. Ability to develop presentation materials for executive level meetings, and lead discussion to gain action on identified opportunities to improve utilization or quality performance

  • Travel is frequent, up to 50% of the month with travel to local, regional Medical Groups/IPAs. Associate is required to reside within the assigned market of responsibility, which must be within the state of CA.

  • Financial assistance will not be provided for relocation.

Preferred Qualifications:

  • Master's degree and or managed care experience at the management level

  • Demonstrated effectiveness in performing statistical analysis and leading presentation of utilization management data, including one-on-one meetings with medical directors/physician leaders

  • Acute inpatient experience

  • Clinical operations experience in the Medical Group/IPA/Hospital and health plan settings

Careers 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)

  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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: Medical Management Consultant, Clinical Consultant, RN, Registered Nurse, Delegated, Managed Care Consultant, Clinic Administrator, Utilization Review, Ambulatory, Concurrent Review, Prior Authorization, Retrospective Review, Discharge Planning, Cypress, CA, California, Work at Home

See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Financial Consultant Partner Fresno CA

Charles Schwab Corporation

Posted 1 week ago

VIEW JOBS 12/3/2018 12:00:00 AM 2019-03-03T00:00 Description: Fresno - CA, BRCA1E, 265 E. River Park Circle, 93720-1548 Alisa Anne Flickinger 20181112-7073 We believe that, when done right, investing liberates people to create their own destiny. We are driven by our purpose to champion every client's goals with passion and integrity. We respect and appreciate the diversity of our employees, our clients, and the communities we serve. We challenge conventions strategically to create value for our clients, our firm and the world. We live and bring to life the concept of 'own your tomorrow' every day. We champion our employee strengths, guide their development, and invest in their long-term success. We hire optimistic, results-oriented, curious, innovative, and adaptable people with the desire to help our clients and one another succeed. As a company, we were established by Chuck over 40 years ago to champion Main Street over Wall Street, and to help Americans transform themselves from earners to owners. Through advocacy and innovation, we work to make investing more affordable, accessible and understandable for all. As we enter our fifth decade, we are looking for talented, innovative and driven people who believe they can help themselves, and our clients, create a better future. Our Opportunity: This position is part of the Branch Network which is primarily responsible for providing Wealth Management to individuals and families to meet their financial needs. In partnership with the Sr. Financial Consultant (FC), the Financial Consultant Partner will support the growth and management of an affluent wealth management practice. This includes servicing clients, growing client relationships, and delivering advice with the practice clients of the Sr. Financial Consultant. The Financial Consultant Partner will help grow the practice by partnering with their Sr. FC to pursue business development opportunities. To learn more about our client offerings visit: Charles Schwab - Investor Services What you'll do: As a Financial Consultant Partner at Charles Schwab, you will operate in a team-based model partnered with one to three Sr. Financial Consultants. In a team-based model, tasks can be completed as directed by your Sr. Financial Consultant(s), in partnership with, or independently with check-ins: * Provide direct, dedicated support for Sr. Financial Consultant(s) and their practice clients. * Interface with existing practice clients via inbound, proactive and follow-up phone calls, and email as well as face to face interactions. * Deepen new and existing client relationships by proactively and reactively uncovering additional business development opportunities and in partnership with your Sr. Financial Consultant(s) to close the business. * Provide advice to include suitability, recommendations, and planning for practice clients in partnership with your Sr. Financial Consultant(s). * Build, refresh, and deliver financial plans for practice clients in partnership with your Sr. Financial Consultant(s). * Update and compile client information through Schwab's internal customer relationship management (CRM) tool. * Identify leads and proactively generate ideas to connect with clients and prospects. * Set and prepare for appointments, e.g., review planning status, life events, suitability updates. * Manage and perform activities in preparation for, and following, client appointments with designated Sr. Financial Consultant(s). * Manage local event administration including venue identification, scheduling, contract negotiation, invitation creation, attendance confirmation, development of client presentations, and follow-up post-event with clients and prospects. * Support the business development and relationship building activities of the Sr. Financial Consultant(s) by following up on referrals and engaging with prospective clients. * Leverage key business partners (Partner Support & Pinnacle) to resolve, research, and respond to client inquiries and issues as well as ensure operational tasks are completed. * Partner with Sr. Financial Consultant(s) to ensure we are providing an exceptional experience for clients ultimately improving client promoter score for the branch. * Participate in or conduct the initial client on-boarding process. * Assist Sr. Financial Consultant(s) with client segmentation and client engagement blue prints; leverage Connect mailings, branch workshops, as well as regional/national events. To learn more about the culture at Schwab, click here to meet our people. What you have: Required minimum skills and qualifications are: * Minimum of 3 years of financial services experience is strongly preferred * Passion for the client with the ability to strengthen and retain client relationships * Results driven, highly motivated self-starter who possesses integrity, a strong work ethic and a passion for helping clients * Demonstrated experience handling client concerns and issues with tact and diplomacy * Strong written and verbal communication skills * Demonstrated ability to handle multiple tasks simultaneously and effectively prioritize * Aptitude for, and experience in, identifying new relationship development * Show a genuine interest in staying current on market events and ability to understand the implications for clients * Ability to uncover and meet client needs and effectively manage client expectations * Demonstrated ability to be agile in changing environmental, economic, and client need scenarios * Operational and/or project management experience * Strong organizational skills with attention to detail * Ability to develop and maintain good cross-enterprise working relationships * Strong problem solving skills * Advanced technical skills, with the ability to utilize different applications at one time, including Windows, internet researching, database systems, and email * Collaborative and team based work style * Ability to retain and execute upon complex information with relative ease * Responsible for understanding and complying with applicable policies and procedures and applying ethical standards to every business activity in which they engage * Maintain the highest ethical standards in the conduct of their business activities and professional dealings and to avoid even the appearance of impropriety * There is a minimum time-in-position expectation of 2 years Education, Licenses, and Designations * Bachelor's degree required * A valid and active Series 7 license is required (may be obtained within a 120 day condition of employment) * A valid and active Series 66 (63/65) license is required (may be obtained within a 120 day condition of employment) * Notary certification (may be obtained after hire) Pursuant to SAFE Act requirements, all employees engaged in residential loan mortgage originations must register with the NMLS registry system and remain in good standing. You will be required to register and to submit to the required SAFE Act background check and registration process. What you'll get: * Comprehensive Compensation and Benefits package * Financial Health: 401k Match, Employee Stock Purchase Plan, Employee Discounts, Personalized advice, Brokerage discounts * Work/Life Balance: Sabbatical, Paid Parental Leave, New Mothers returning to work Program, Tuition Reimbursement Programs, Time off to volunteer, Employee Matching Gifts Program * Everyday Wellness: Health and Lifestyle Wellness Rewards, Onsite Fitness Classes, Healthy Food Choices, Wellness Champions * Inclusion: Employee Resource Groups, Commitment to diversity, Strategic partnerships * Not just a job, but a career, with an opportunity to do the best work of your life Learn more about Life@Schwab. Charles Schwab & Co., Inc. is an equal opportunity and affirmative action employer committed to diversifying its workforce. It is Schwab's policy to provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), gender identity or expression, national origin, ancestry, age, disability, legally protected medical condition, genetic information, marital status, sexual orientation, protected veteran status, military status, citizenship status or any other status that is protected by law. Schwab also does not discriminate against applicants or employees because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. At Schwab, we believe that every employee, through their diverse abilities and experiences, can contribute to our growth, innovation and client loyalty. We embrace diversity and are committed to providing equal opportunity to all employees and applicants. If you have a disability, and require reasonable accommodations in the application process, call Human Resources at 800-725-3535. We will be happy to assist you. Schwab will only share your accommodation request with those individuals who have a specific need to know. The request for an accommodation will not affect Schwab's hiring decisions. All other submissions should be performed online. Job Specifications Work Schedule:DaysLanguages:English - spokenCurrent Licenses / Certifications:FINRA Series 66, FINRA Series 7Relevant Work Experience:Business Development and Sales-2-5 yrs, Customer Service-2-5 yrs, Brokerage Operations-2-5 yrs, Financial Services-2-5 yrsPosition Located In:CA - FresnoEducation:BA/BSJob Type:Full Time Category:Brokerage Operations & Trading Activation Date: Wednesday, November 14, 2018 Expiration Date: Sunday, December 16, 2018 Apply Here Charles Schwab Corporation Fresno CA

RN Medical Management Consultant - Southern CA

Expired Job

Unitedhealth Group Inc.