Analyst Program Assoc (Critical Incidents Analyst)

About the position At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The PathWays Reportable Incidents Analyst receives and investigates all Home and Community-Based Services (HCBS) critical incidents, Abuse, Neglect, and Exploitation (ANE) critical incidents, and those identified as other critical incidents to increase effective management of unusual occurrences following federal regulations and state rules. This position is responsible for stringent timely submissions to FSSA and has ongoing communication and collaboration with internal and external health plan partners. This individual will track and trend information to assist in applying and interpreting data relative to critical incidents. The PathWays Critical Incidents Analyst ensures compliance with regulatory requirements related to PathWays and maintains a constant state of audit readiness.

Responsibilities

• Analyze reports to determine if the identified instances meet the threshold for a critical incident
• Support in state investigations for Mortality review
• Determine if abuse, neglect, or exploitation has occurred. If ANE is reasonably suspected, file or direct the designee to file a report with APS
• Ongoing assessment and management of any immediate potential threats to member health, safety, and welfare and take immediate action to ensure member safety
• Determine whether additional information is required from the provider or other parties related to critical incidents and secure and review additional details as needed
• Notify the member, as needed, other service providers and health plan partners about the reported critical incident and related issues and concerns regarding the process and mitigation
• Conduct full investigation and ensure its completion within thirty (30) days
• Oversee corrective actions to ensure that the conditions that led to the critical incident no longer exist
• Participate with the interdisciplinary team as needed
• Document according to industry-standard guidelines
• Implement and maintain necessary databases to complete standard reports and analyses within established timelines
• Complete ad hoc reports as requested
• Routinely analyze results to identify trends or errors
• Interface with multiple internal clinical staff and external providers to gather information related to Critical Incident Management
• Manage assigned special projects to completion within established target dates
• Identify, implement, and monitor opportunities for best practices and standards
• Maintain positive relationships with internal and external partners such as state representatives or share services partners
• Use creativity to solve problems
• Demonstrate leadership in continuous improvement
• Utilize change management to drive results
• Develop recommendations for quality remediation plans
• Drive consistency and efficient processes on the team
• Actively participate in quality improvement initiatives / meetings
• Provide assistance to the Indiana HealthPlan outside of regular business hours and on holidays for ANE and Critical Incidents as deemed necessary

Requirements

• 2+ years in a Healthcare related field
• 2+ years of full-time direct service experience with older adults or persons with disabilities (this experience includes assessment, care planning, and monitoring)
• 2+ years of experience working within a Health Care or Managed Care environment, State Government Health, Human Services, or Healthcare business areas
• Proficient in Microsoft Office including Word and Power Point and advanced Excel skills
• Ability to work in a high-paced environment with tight deadlines
• Flexibility to conduct occasional in-person home or community member visit, within their area of coverage, as indicated

Nice-to-haves

• RN, LPN, BSW or MSW within the state of Indiana
• 2+ years of experience in related Healthcare Business Analysis including performing analysis, reviews, forecasting, auditing and trending complex data to support continuous quality improvement
• 1+ year of experience with including Adult Protective Services (APS), Justice System, Long-Term Services and Supports (LTSS) and/or Long-Term Care (LTC) Ombudsman
• Solid experience in tracking and trending CI/ANE data
• Experience in a Managed Long-Term Services and Supports (MLTSS) environment
• Medical record review experience
• Knowledge of health care products, delivery systems, claims processing and supporting systems
• Knowledge of quality improvement methods and tools (SPC, Six Sigma)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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