Optum · 1 month ago
Field Base Clinical Practice Performance Consultant - Orlando, FL
Orlando, FL
Full-time
Onsite
Mid Level
$59K/yr - $105K/yr
3+ years expOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The role involves coordinating care through physician practices to improve clinical quality and documentation, while also assisting members with their healthcare needs and resources.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Provides care coordination through physician practices for members to improve clinical quality and clinical documentation
May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
May interact with members via telephone; Schedule appointments, Follow-up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed that relate to preventative health screenings or HEDIS gaps in care
Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice
Partner with the practice's administrative and clinical staff while managing member appointments and data between visits
Create and maintain a professional and supportive relationship with the member, provider and office staff
Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services
Assists the member to access community, Medicare, family and other third-party resources as appropriate
Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the appointments, screening or care related to preventative health screenings or HEDIS gaps in care
Provides education to members regarding health care needs and available services related to preventative health screenings or HEDIS gaps in care
Works to facilitate member compliance with their appointments, screenings, medications and/or action plans to complete open care opportunities/HEDIS gaps in care
Identifies barriers for compliance in preventative health screenings or HEDIS gaps in care and communicates with members and providers to formulate action plan to address
Documents member conversations and activities in Optum/UHC programs. No documentation in provider EMRs and/or member charts
Maintains a focus on timely, high-quality customer service
Maintains the confidentiality of all sensitive information
Qualification
Required
Current, unrestricted RN license in the State the staff member resides in as well as any state member outreach is performed
3+ years of clinical experience in a hospital, acute care, home health, direct care or case management
Proven computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and Excel
Demonstrated problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Proven 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 ability to understand and interpret complex information from others
Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities
Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect
Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s)
Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
Ability to travel approximately 75% of the time in the assigned regional area (Orlando FL) as business needs dictate
Must be able to travel to provider offices within service area - may require up to 1-hour radius for travel
Access to Reliable transportation, valid and unrestricted driver's license, proof of insurance and ability to travel to provider offices or other locations within service delivery area
Preferred
Bachelor of Science in Nursing
Case Management experience including Certification in Case Management
Experience with HEDIS and EMR (electronic medical records)
Experience with navigating and analyzing reports in Microsoft Excel
Medicaid, Medicare, Managed Care experience
Physician office experience
Home care/field-based case management
Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Call Center experience
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
Company data provided by crunchbase