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Optum CO is seeking a Senior Manager of Transitional Care Embedded Program & CDQI to join our team in Golden, CO. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. Primary Responsibilities:
- Conduct Comprehensive Wellness visit of Optum members Work within OptumCare proprietary EMR systems when conducting wellness visits
- Approximately 85% daily travel within Denver market
- Interface with physicians and/or medical group staff professionally developing credibility
- May need to attend future continuing education classes to keep abreast of medical advancements and innovative practice coding, Risk Adjustment guidelines
- Provides ongoing, targeted mentoring and education to physicians and APCs on appropriate diagnosis coding and supporting documentation including:
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- Risk education sessions and materials for clinicians in both primary care and specialties
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- Organization-wide training on changes or updates to HCC Coding
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- Communication on new suspected conditions
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- Programs designed to ensure all diagnosed conditions and appropriate codes are supported by documentation in the patient chart
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- Educates physicians and APCs to ensure appropriate practices related to risk adjustment activities, HEDIS measures and gaps in care throughout the market
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- Works with the Medical Director, Risk Adjustment to establish a competency baseline for provider performance. Monitor the progress of providers receiving mentoring and develop tailored strategies to improve performance
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- Informs physicians and APCs around year-over-year changes to the Medicare risk adjustment to provide thought leadership and assists in carrying out recommended actions
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- Partnership with operational leaders:
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- Builds/maintains/manages market stakeholder relationships across multiple layers and functions
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- Monitor wrap around programs for effectiveness and assist in coordination, adoption and resolving barriers as needed to achieve outcomes
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- Participates in regulatory and accreditation activities, as applicable
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- Emotional maturity for effective change management
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- Establish solid and lasting, trust-based relationships within team and external partners
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- Foster exemplary teamwork and strengthen a culture of continuous improvement and accountability
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- Take initiative and self-start attitude to approach problems with energy and passion
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- Demonstrate preference for working in a tight-knit team environment with diverse professional groups
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- Utilize a solid fact base to influence and lead physicians and support staff to implement change programs
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- Ensures overall program success
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- Reducing barriers for program implementation teams, including anticipating and responding to potential roadblocks
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- Active problem solving to meet evolving challenges in a highly dynamic environment
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- Distributing performance management reporting to market leaders and synthesizing information for adjustment and optimization
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- Conducts deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
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- Works collaboratively to inform new, innovative, or complimentary program ideas at scale
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- Collaborates with other team members to align on meeting expectations and material preparation
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- Interacts with senior management by providing thoughtful analysis on key decision points to drive initiatives forward
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- Local travel to provider locations as needed
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- Other duties as assigned and participate in early morning and evening meetings as needed
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- Conduct clinical hours one day weekly within our Optum clinics or as an Embedded APC
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- Percentage of time will be spent in Education (75%), percentage of time in leadership (20%), percentage in Clinical Duties (5%)
As an Employer of choice, we offer a full comprehensive range of benefits and attractive compensation package:
- Guaranteed base and bonus potential
- Med/Den/Vis, STD, LTD, 401k with match
- Professional Liability
- PTO Accrual
- CME Time and Reimbursement
- Stock Purchase Option/Executive Savings Plan
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:
- Current, unrestricted Colorado APRN or PA License or ability to obtain within 90 days of employment
- Prescribing Authority or ability to obtain prior to employment
- Family, Geriatrics, or Adult experience
- Flexibility to work in various care environments such as Primary, Post-Acute, Acute and Home visit
- Valid driver's license or access to reliable transportation
- Drive through the Denver metro area to see patients (mileage reimbursement available)
- DEA or ability to obtain
- You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
Preferred Qualifications:
- 1+ years of clinical experience in their highest level of education (met 2000 hrs. to practice autonomously)
- Proficiency with Microsoft Excel, Word, PowerPoint, Outlook
- Experience with HCC coding guidelines in Primary Care
- 2 years of experience working in a managed care health plan environment
- Knowledge of Value Based Care Model
- HEDIS, Coding, Risk Adjustment knowledge
The salary range for this role is $104,500 to $156,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Optum
401(k), mileage reimbursement
Jan 29, 2025