Licensed Vocational Nurse LVN/LPN HEDIS Healthcare Navigator San Antonio TX

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work. (sm)WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic stat that understands and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.The Healthcare Navigator is responsible for successfully supporting patient/member in navigating the healthcare system, coordination of care, and improving patient experience. The Navigator will assist in driving consistency, efficient processes and share best practices to improve patient experience and perception, in a collaborative effort with all areas of the business– designed to facilitate a minimum 4 Star rating. The Healthcare Navigator will participate in STAR Performance improvement initiatives, such as CAPHS and HOS Remediation and Intervention, SDOH screening, LIS/MSP enrollment assistance, Reduction of Disenrollment, CTM, HEDIS gap closures, and other department initiatives; develop recommendations for quality remediation plans and create tools to capture relevant data for each region. This position will work collaboratively with other staff members, leadership, Market staff, and clinics in a matrix relationship.Primary Responsibilities:

Support CAHPS and HOS business plans to motivate providers and clinic staff to engage in improving overall Star performance to be 4 STARS or higher

Provide member/patients with internal and external resources to improve Social Determinants of Health, and CAHPS and HOS measures

Manage outreach campaigns, including inbound calls and calls made via the dialer system

Perform required assessments such as Care of Older Adults, and other HEDIS campaign initiatives to help close gaps in care

Provide exceptional customer service in all interactions with members at all times

Perform data mining in all systems to help close gaps in care

Be the primary go to person for assigned Stars related activities within their assigned market(s) working within a matrix relationship which includes other Quality staff, leadership, and Market staff

Assist in developing and improving training and analytical materials for assigned Stars improvement campaigns

Analyze and evaluate provider group structure, characteristics, office operations, and personnel to identify the most effective approaches and strategies for improving patient perception and experience

Identify and assess decision makers and other key areas of Medical Management with a focus on identifying barriers to achieving targeted outcomes

Focus communications and efforts accordingly

Develop solution-based, user friendly initiatives to support practice success

Participate in daily huddles, and CAHPS HOS improvement meetings

Perform accurate and timely documentation in Excel workbook, and in other systems

This is an office base position near Farinon Dr., 78249/Walmart, United Healthcare building, Southwest Business Corporation (SWBC) buildingYou’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 Texas LVN license or compact license

1+ years of HEDIS/Stars experience

3+ years associated business experience with health care industry

Professional experience persuading changes in behavior

Knowledge base of clinical standards of care, preventative health, and CMS Star measures

Experience in managed care working with network and provider relations

Basic knowledge of Microsoft Office programs, including Word and Excel

Ability to accurately document information and maintain patient confidentiality

Preferred Qualifications:

1+ years of Call Center Experience

Strong communication and presentation skills

Strong relationship building skills with clinical and non-clinical personnel

Demonstrated ability to interact with internal and external staff, peers, and internal company staff at all levels

Ability to solve process problems crossing multiple functional areas and business units

Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

Medical/clinical background highly desirable

Bilingual preferred

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi - specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)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: WellMed, Healthcare, Bilingual, Licensed Vocational Nurse, LVN/LPN, Primary Source Verification Process, HEDIS/STAR, Consultant, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, 78249, Texas, TX