Career Opportunities

This person will provide clinical leadership for a team of physicians, nurses and social work professionals by incorporating team work, understanding of latest research and innovative approaches to managed care and identifying and implementing best practices.

Responsibilities & Duties:

  • Provide medical direction and support for care management, including inpatient and outpatient care management.
  • Support policies and procedures to ensure regulatory compliance including by not limited to NCQA and CMS.
  • Represent United Physicians in interactions with external customers such as hospitals leadership, state and national organizations, physician groups and health plans.
  • Provide leadership and clinical expertise in developing new strategies to improve performance at the physician, practice and network level.
  • Work with network participating physicians and leadership to implement processes that improve performance.
  • Work proactively with health economics and analytics team to identify opportunities for improvement.
  • Develop and implement strategies to effect positive change toward population health management.
  • Identify opportunities for improvement for practitioners.
  • Assure quality performance adherence to clinical practice guidelines and evidence-based medicine, and collaborating with other departments as needed.
  • Perform other duties as assigned.

Performance Skills:

  • Problem solving and acceptable, cost effective resolutions.
  • Written and verbal communication is essential.
  • Leadership skills and responsibilities.
  • Positive attitude.
Qualifications:
  • MD or DO degree required.
  • Valid driver's license.
  • Completion of a three year US residency.
  • Board Certification.
  • Valid Michigan physician license.
  • Minimum seven (7) years of clinical practice beyond post-graduate training.
  • Demonstrated commitment and understanding of population management and health status improvement.
  • Minimum of three (3) years relevant management experience in health care organizations or ina managed care organization.
  • Minimum of two years' healthcare experience.

Responsibilities & Duties:

  • Accurately identify and stratify patients with chronic conditions that would benefit from case management and identify opportunities for care management services through claims information, pharmacy, hospital admission information, provider referrals, and/or registry information.
  • Perform comprehensive assessment of patient and gather information concerning the patient's health behaviors, clinical influences, cultural/social beliefs and community resources needs.
  • Collaborate with the patient and the multidisciplinary health care team to develop an individualized and evidence based plan of care.
  • Communicate directly with the patient/family/PCP to incorporate patient's needs in order to prepare the patient to make informed and appropriate decisions.
  • Provide education to patient/family to prevent risk behaviors and promote and achieve positive health and wellness outcomes.
  • Engage patients in goal setting to achieve optimal health, and use clinical judgement to assist patients in overcoming barriers to goals.
  • Efficiently document assessments, clinical findings, healthy lifestyle, preventive service, self-management strategies, plan of care, and evaluate the effectiveness of care plans and progress toward goals.
  • Develop reports and collect data on case activity and outcome analysis
  • Monitor and document the quality of care which includes:
    • The patient's response to provided services.
    • Determining if goals of the care plan are being achieved.
    • Review whether goals remain appropriate and realistic.
    • Determine what actions may be implemented to enhance positive outcomes.
    • Promote self-management and care coordination
    • Actively promote frequent communication between all team members, providers, patients and their families to enable a smooth tranistion from one level of care to another to assure quality care is provided during transitions of care (moderate level care to complex care to disease management).
    • Demonstrate self-directed, self-motivated, responsible behavior.
    • Recognize when there is a need for adjustment and flexibility as changes occur in patient activity, workload and needs.
    • Demonstrate appropriate judgement skills to be able to make independent clinical decisions in patient care matters.
    • Recognize, respect and utilize the special abilities and skills of other professionals.
    • Adhere to the scope of practice for Registered Professional Nurse or Social Work per state regulatory guidelines
    • Respect confidentiality of all persons and follows state, federal and organization policies and procedures.
    • Effectively participate on various internal committees and performs other duties as requested by management.
Qualifications:
  • Valide unrestricted State of Michigan Nursing or Social Work License required.
  • Valid State of Michigan Drivers License.
  • Two years of case management outpatient/discharge planning or related experience.
  • BSN preferred or MSW preferred
  • Pediatric experience preferred
  • Knowledge of clinical criteria/guidelines for preventive services and chronic disease management.
  • Knowledge of community resources also a plus.
  • Home health nursing experience background is a plus.

Responsibilities & Duties:

  • Review and analyze data in support of initiatives to reduce the use of inappropriate imaging.
  • Write scripts and queries to investigate clinical and financial issues.
  • Review and analyze physician data and reports
  • Update Practice Unit Super Matrix and sub-reports by department
  • Participate in various PGIP/PCMH projects.
  • Develop clinical quality reports using various data sources.
  • Reconcile data between databases
  • Respond to physician offices' inquiries and requests for reports.
  • Conduct Adhoc reporting for departments/practice units using Crystal Report Writer, Excel, Access and SQL.
  • Work on special projects assigned by manager
Qualifications:
  • Bachelor degree in Finance, Accounting and/or Information Technology (required).
  • Two to three (2-3) years experience in facility claims data analysis (required).
  • Knowledge of medical terminology
  • Background in health care is mandatory
  • Excellent written and verbal communication

Performance Skills:

  • Experience with Crystal Report Writer or similar reporting software.
  • Knowledge of relational databases.
  • Proven experience with Microsoft Excel, Access and SQL.

Responsibilities & Duties:

  • Develop and design specifications to meet the project requirements.
  • Develop, test and document programs, modules, and job control language to meet project requirements.
  • Provide written documentation to support the use and future maintenance of software programs.
  • Review applications performance for accuracy and efficiency of program solutions through the use of code reviews and/or project walk-through.
  • Develop IS Operational Procedures.
  • Communicate written and oral operational requirements and procedures to the IS Programming Team for running and troubleshooting process solutions.
  • Provide weekly project progress updates for all assigned projects.
  • Coordinate new Oracle table development initiatives ensuring consistency and integration with existing data warehouse structures.
  • Investigate and resolve data quality issues that may result from input or process problems, propose corrective actions, and work with various departments and staff for resolution.
  • In charge of data inputs and outputs on an operational basis.
  • Assist in continuous improvement efforts towards enhancing performance and increased functionality.
  • Work on special projects assigned by the Director of Programming & Technical Services.

Qualifications:

  • Bachelor's degree in computer related field and at least 3 years programming experience.
  • Must have a solide Oracle background using SQL Loader and Developer Suite applications.
  • Experience in creating packages, procedures, triggers and other Oracle Database objects.
  • Programming experience with MS Access, Visual Basic, BO Crystal Reports, TOAD, and web development tools preferred.
  • Ability to work in individual and team environments, manage multiple priorities and meet deadlines.
  • Experience in business process analysis and related projects
  • Experience with health care applications preferred.
  • Familiarity with Window 2003 operating system.
  • Experience with Oracle 10g or 11g is required.
  • Analytical and problem-solving skills demonstrated in a timely manner producing quality deliverables.
  • Excellent written and verbal communication along with interpersonal skills.

Responsibilities & Duties:

  • Administrative support of the BUCP Quality Committee in the following activities.
    • Set agendas, develop materials and minute documentation.
    • Presentation of materials to support the development and mainenance of a quality program (initiative selection, target and threshold setting, support programs).
    • Remediation activities.
    • Policy and procedure development to support the quality program.
    • Alignment of quality program with key health plan and regulatory initiatives within markets.
  • Responsible for leading the development, tracking, and implementation of the CI quality, outreach programs, and quality based projects.
  • Responsible for the education and training processes for quality measures and reporting techniques of all participating physician practices sites.
  • Leads evaluation of the CI program initiatives for effectiveness and alignment with PO and health system priorities and manages regular process to assess and improve the CI quality program
  • Serve as a primary contact for physician members who would like to propose new initiatives to be included in the CI program review.
  • Analyzes and interprets clinical quality, cost, utilization data in collaboration with Health Economics and Analytcs Team (HEAT).
  • Identifies best practices in regards to the delivery of high quality, cost-efficient care in the hospital and physician practice settings.
  • Collaborates with managing director and other departments to develop annual ROI estimates for the CI program.
  • Other duties as assigned.

Qualifications:

  • Graduate of an accredited school of nursing as a Registered Nurse.
  • Proficiency in MS Office Suite - Word, Excel, PowerPoint, Project.
  • Experience managing projects that successfully achieve budget and timeline goals.
  • Proven verbal and written communication skills.
  • Ability to engage in critical thinking and creative problem solving.
  • Familiarity with a variety of project management methodologies.
  • Superior analytical abilities:  ability to understand member's business issues.
  • Proven organizational skills and ability to balance multiple projects.
  • Ability to lead and motivate cross-fuctional teams and interact with all levels.
  • Ability to define project management processes, tools, and templates as required for the project.
  • Professional experience with Patient-Centered Medical Homes and with National Committee for Quality Assurance standards.
  • Master's degree preferred.
  • Experience in healthcare focused implementations.
  • Intellectual curiosity and persistence, and creativity in problem solving.

Responsibilities & Duties:

  • Analyze and correct production support problems, and propose changes to the processes to reduce the reoccurrence of similar problems.
  • Investigate new technology and software to increase efficiency of processes.
  • Develop and design specifications to meet the project requirements.
  • Ability to work collaboratively with others in the department, other employees or external clients.
  • Develop, test, and document programs, modules, and job control language to meet project requirements.
  • Provided written documentation to support the use and future maintenance of software programs.
  • Review applications performance for accuracy and efficiency of program solutions through the use of code reviews and/or project walk-through.
  • Develop IS Operational Procedures.
  • Communicate written and oral operational requirements and procedures to the IS Programming Team for running and troubleshooting process solutions.
  • Provide weekly project progress updates for all assigned projects.
  • Coordinate new Oracle table development initiatives ensuring consistency and integration with existing data warehouse structures.
  • Investigate and resoluve data quality issues that may result from input or process problems, propose corrective actions, and work with various departments and staff for resolution.

Qualifications:

  • Bachelor's degree in a computer related field and at least 10 years programming experience.
  • Must have a solide Oracle background using PL/SQL, SQL, SQL Loader and Developer Suite applications.
  • Experience in creating packages, procedures, triggers and other Oracle Database objects.
  • Programming experience with MS Access, Visual Basic, BO Crystal Reports, TOAD, and web development tools preferred.
  • Experience with HL7, Mirth and JAVA scripting a plus.
  • Ability to work in individual and team environments, manage multiple priorities and meet deadlines.
  • Experience in business process analysis and related projects.
  • Experience with health care applications preferred.
  • Familiarity with Window 2003 operating system.
  • Experience with Oracle 11g is required.
  • Analytical and problem-solving skills demonstrated in a timely manner producing quality deliverables.
  • Excellent written and verbal communication along with interpersonal skills.

Disclaimer:  The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

If you are interested in applying for an available position, please contact Nicole Delly in Human Resources at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

 
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