Population Health Manager - Telecommute in FL

Careers at UnitedHealth Group

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To promote our mission of helping people live healthier lives, the Population Health Manager is responsible for initiating new and managing ongoing projects within a coordinated, population-focused quality improvement strategy. The main goal for the Manager is to improve health outcomes for their assigned population(s) as measured by HEDIS and other key quality metrics. The Manager works within highly matrixed relationships to implement member-facing, provider-facing, and systems interventions to drive continuous improvement in gaps in care closure to meet the needs of the members and the Plan. The Manager collaborates across multiple functions that may include Clinical, Network/Provider Engagement, Member Experience, Benefit Design/Product, Compliance, Policy, Community Outreach, Behavioral Services, and Pharmacy.

If you are located in the state of Florida, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Coordination of activities within a quality improvement strategy to drive performance improvement toward established quality and affordability goals, regulatory compliance, and adherence to accreditation standards, specific to assigned member population(s)
  • Incorporating applicable accreditation, regulatory, and business requirements into programs and projects
  • Document programs and interventions, and support measurement and monitoring of program effectiveness
  • Facilitate programs for Performance Improvement Projects (PIPs)
  • Contribute documentation to Trilogy Documents, Committee presentations, Population Health and Disparities Plans
  • Monitor performance over time against established performance goals; identify opportunities for improvement (i.e., geographic, demographic)
  • Review literature, feedback from committees, and other stakeholders to identify and document barriers to care for their assigned population(s)
  • Develop and manage health promotion and member education programs that aid members with accessing care
  • Act as liaison to community partners serving members in assigned population(s); facilitate programs that connect members with community resources; offer "train the trainer" and health education expertise to community partners
  • Profile network provider performance on assigned measures and outreach to under-performing providers for focused quality improvement projects; coordinate quality of care follow-up with leadership
  • Work with Clinical teams to align programs for specific populations (i.e., disease management, case management, medication management, and clinical affordability)
  • Using quality and utilization data
  • Triage member needs and facilitate escalation of high-risk members for case management and/or clinical intervention
  • Identify trends in care and utilization resulting new improvement programs
  • Act as a clinical subject matter expert to team members, including peers (i.e., nurses, physicians, dentists, and pharmacists), health plan leaders, external stakeholders, and network providers
  • Complete special projects as assigned
  • Ability to organize and manage program implementations

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:
  • Bachelor's degree in nursing or equivalent experience
  • Current, unrestricted RN license in Florida
  • 3+ years of clinical experience with an emphasis on Medical/Surgical and Complex/Chronic Care, including a comprehensive understanding of coordination of care principles, developing shared integration tools and collaboration principles across a multidisciplinary team both internal and external
  • 3+ years of quality improvement experience
  • Experience working with data in a variety of databases and manipulating these systems at the same time
  • Experience working in the community, including face to face or telephonically with providers and across specialties (Primary Care, Pediatrics and Behavioral Health)
  • Experience making formal presentations in front of committees and work group environments and using virtual technology (I.E: Microsoft Teams/Web X)
  • Experience reviewing available literature and make recommendations for strategic improvements in member-, provider-, and community-facing programs, as well as to internal processes and systems
  • Intermediate level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, Internet browsers, EMRS and Practice Management Software

Preferred Qualifications:
  • Master's degree in nursing, public health, or similar area
  • Certified Professional in Healthcare Quality
  • Experience integrating medical and behavioral health care in an outpatient setting
  • Experience in bringing together cross-functional teams to complete PI Project
  • Comprehensive understanding of Privacy Laws (HIPAA)
  • Knowledge base of HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
  • Knowledge of Health Information Exchanges (HIE), Electronic Medical Records (EMRS)
  • Use of industry standard Quality Tools and Methodology
  • Ability to review and interpret Managed Care Contracts

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

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

For more information on our Internal Job Posting Policy, click here.

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: Quality Improvement Nurse, HEDIS Nurse, L&D Nurse, Maternal Child Nurse, Public Health Nurse, Nurse, RN, Quality, HEDIS, NCQA, Maternal Child, L&D, Labor and Delivery, Public Health, Healthcare, Quality Improvement, CPHQ, Managed Care, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, Jacksonville, FL, Florida, UHC, UnitedHealthcare

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