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

    • San Antonio, TX

Position Description

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)

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) building

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:

  • Current License Vocational Nurse (LVN)

  • 1 year 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 350,000+ 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

With offices around the world, UnitedHealth Group's headquarters are located in the Minneapolis metropolitan area.

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