Patient Care Coordinator

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Associate Patient Care Coordinator performs quality assurance processing for data submitted to Data RAPs (DRAP) from medical records, lab results, or PSU screening test results in support of the preventive exam visits for WellMed Quality Program Audit.

They will conduct ongoing training with the PSU MA/LVN staff to prevent errors and improve quality assurance and effectiveness of data submission and reporting of quality screenings exam results completed annually.

Performs other audit and medical record research duties as assigned including focus projects.

Schedule: Monday to Friday, 8 AM-5 PM

Location: Onsite - 19500 W Interstate 10, San Antonio, TX 78257

Primary Responsibilities:

• Performs quality assurance audits using medical records and supporting information using WellMed systems such as ePRG, eCW and DRAPs Chart finder with duties including but not limited to:

• Reviews and conducts quality audits of all patients seen at a PSU clinic in contrast with the Quality Summary report (Pink Box Report). Any measure that did not process and upload to the Pink Box report is reviewed to ensure medical criteria was met. If criteria are met and item is not processing, it is considered a glitch and is forwarded to the QRA desk for assistance. The goal is to ensure all results are processed and show accurate status on Quality Summary Reports
• Research any discrepancies between eCW PSU visit note and the Pink Box report. The review will consist of comparing eCW screenings, vitals and surveys complete with the pink box report. Current year data available in any WMMI system but is showing needed by the Pink Box report will be submitted for processing
• Identify trends and patterns of documentation or system errors. Report any outliers or patterns of measures not processing to the Regional Manager
• Apply quality program criteria to medical information submitted to close the measure to ensure compliance with WellMed Program standards
• Demonstrate expertise in knowledge of quality review guidelines, criteria of each measure and documentation standards for issues or concerns found during audit
• Maintain productivity levels as determined by the market to ensure audit findings are submitted to DRAP and forwarded to leadership timely
• Monitor progress towards completion of all documentation found on audit until the data is processed by DRAP. Any items submitted upon audit should be tracked as a recheck to follow until the measure has cleared the Pink Box Report
• Identifies data errors, inappropriate results, and faulty or inefficient processes that may be performance issues or system issues. The results of the audit should be shared with the market manager at least monthly for quality improvement
• Attend Regional Audit meetings held by the regional manager to ensure updates, compliance and announcements about the audit processed are received by auditor and shared with market PSU team: it is essential to hold meetings with management to communicate audit findings to identify training needs and system problems to improve quality performance
• Complete market tracker reports provided to leadership to show market performance and utilization of work complete. Ensure tracker information is highly accurate with detailed to improve audit function post clinic audit review
• Work collaboratively with Regional Manager and PSU staff to ensure teams have working knowledge of quality program standards and techniques performed at PSU screening clinics: concerns identified by review of test results and medical information submitted should show above 90% compliance
• Review screening results submitted to determine accuracy in documentation, criteria and date requirements required by the quality program nurse reviewer
• Identify patterns of results submitted that failed validation due to documentation errors or technique used to conduct screenings: recognize staff who are performing at high level and offer partner training for staff who may have issues with technique
• During audit finding discovery, isolate PCP office submissions that require education due to patterns of failed validation submitted by the office staff
• Offer advice regarding quality reporting to managers to improve staff performance at PSU clinics to prevent multiple visit and patient abrasion
• Reach out to other markets that may be performing well in a specific area to improve performance in each market. Reaching across markets may offer the teams new ideas to reach their expected results and goal outcomes
• Network with market PSU team as well as regional teams to ensure you have a collaborative team to help with problem resolution, share ideas, and improve outcomes across all markets
• Performs all other related duties as assigned

Required Qualifications:

• High School Diploma/GED (or higher)
• 3+ years of medical experience working with WellMed quality program as a user or reviewer
• Advanced level of proficiency with PC software computer skills such as Microsoft Word, Excel, Power Point
• Intermediate level of knowledge of medical terminology and anatomy
• Ability to organize, prioritize, plan, and handle multiple tasks, demands simultaneously

Preferred Qualifications:

• Knowledge of ICD10/CPT coding of encounter data pertaining to HEDIS measures
• Independent problem identification/resolution and decision-making skills
• Excellent written, verbal and communication skills
• Detailed oriented, conscientious and systematic with a high level of accuracy in submission of data/forms
• Strong communication and inter-personal skills to establish and maintain effective working relationships with PSU Team and all other internal/external customers

Physical & Mental Requirements:

• Ability to lift to 30 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

The salary range for this role is $16.00 to $28.85 per hour 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.