The RN Clinical Practice Consultant is field-based position to cover the Milwaukee Wi area.

The RN CPC is a a plan patient-centered care coordinator  who will interact face to face, by phone and email with physician  practices, including their health coaches/or designated care managers to identify members who might benefit from the Healthier Lives Model of Care.

The work schedule is 8:00 am - 5:00 pm (cst), Mon- Fri- (NO weekends or holidays!)

The RN Clinical Practice Consultant would support member identification for engagement through the use of health status profiles, health surveys, claims-based data and other source information. He/she would utilize developed plan policies and procedures regarding confidentiality and privacy; identify and relate health action plans based on member profiles, conditions, available benefits; and, act as a liaison-coordinator-navigator to available UHC programs and services, including but not limited to  a pain-depression program, disease state management appropriate services, education and self-management tools, identified and available community resources. This position would allocate time and resources efficiently through the use of available evidenced-based medicine, medical director support, collaboration with other UHC positions, all while acting as a key point of consultation and coordination with the practice on behalf of engaged members, their caregivers and their practitioners.  

Responsibilities of this role include:

• Be a resource for health literacy and cultural sensitivity tools and opportunities.
• Review member reports and track and report health outcomes and key indicators of utilization, quality, member and physician satisfaction measures over time in a plan-do-study-act continuous quality improvement approach.
• Promote transparency of available UHC available member programs, services (including mental health and social support) to physician practices where based on engaged, or likely to be engaged members.
• Promote relationships with internal contacts to best triage member needs to best available UHC programs/services.
• Be compliant with all UHC policies and procedures and be aware of and compliant with all external regulatory and compliance bodies.
• Function as a member advocate at all times.
• Tracking barriers, lessons learned and successes to contribute to future improved iterations of activities and projects.

Job Qualifications include:

• Active and unrestricted RN licensure for the state of WI
• A Bachelor's degree- preferably in nursing or healthcare
• 2 years of RN work experience in managed care (healthplans) is preferred; and experience at a medical office practice is a plus
• Basic understanding of health surveys, health literacy, disease state management, case management, statistics and measures of illness burden.   MBA beneficial, but not required.
• A good listener, interviewer and communicator.
• A basic understanding of the nature of complex illness and co-morbidities.
• Familiarity with health coaches, health prevention, HEDIS, NCQA, health registries and patient-centered care

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

 UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

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