Pathways Critical Incidents Analyst - Remote in Indiana

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 Critical 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. The individual compiles and maintains report data in a standard format to support the PathWays Program. This position is responsible for timely submissions to FSSA and 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.

If you reside in Indiana, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities
• Analyze reports to determine if the identified instances meet the threshold for a critical incident
• Determines if abuse, neglect, or exploitation has occurred. If ANE is reasonably suspected, files or directs the designee to file a report with APS
• Assesses and addresses any immediate potential threats to member health, safety, and welfare and takes immediate action to ensure member safety
• Determines whether additional information is required from the provider or other parties related to critical incidents and secures and reviews additional details as needed
• Notifies 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
• Conducts full investigation and ensures its completion within thirty (30) days
• Oversees corrective actions to ensure that the conditions that led to the critical incident no longer exist
• Participates with the interdisciplinary team as needed
• Documents according to industry-standard guidelines
• Implements and maintains necessary databases to complete standard reports and analyses within established timelines
• Completes ad hoc reports as requested
• Routinely analyzes results to identify trends or errors
• Interfaces with multiple internal clinical staff and external providers to gather information related to Critical Incident Management
• Manages assigned special projects to completion within established target dates
• Identifies, implements, and monitors opportunities for best practices and standards
• Maintains positive relationships with internal and external partners such as state representatives or share services partners
• Use creativity to solve problems
• Solid clinical judgment
• Demonstrate leadership in continuous improvement
• Utilize change management to drive results
• Develop recommendations for quality remediation plans
• Share best practices and support team goals and objectives
• Drive consistency and efficient processes on the team
• Actively participate in quality improvement initiatives / meetings
• Responsible for maintaining and increasing self-proficiency in the use of quality tools and methods and the application of quality science
• Provides assistance to the Indiana HealthPlan outside of regular business hours and on holidays for ANE and Critical Incidents as deemed necessary
• Position may require some travel for face-to-face engagement or support, as indicated

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
• Associate’s degree or higher in Social Services, or Healthcare related field or 2 years of relevant experience
• 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
• Proven ability to work in a high-paced environment with tight deadlines
• Proven flexibility to conduct occasional in-person home or community member visit, within their area of coverage, as indicated

Preferred Qualifications
• 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
• Solid experience in tracking and trending CI/ANE data
• 1+ years of experience with including Adult Protective Services (APS), Justice System, Long-Term Services and Supports (LTSS) and/or Long-Term Care (LTC) Ombudsman
• In-person home or community member visit, within their area of coverage, as indicated
• 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)

Soft Skills
• Excellent interpersonal and communication skills
• Reporting skills and solid analytical skills
• Ability to write clearly and help with word processing when necessary
• Ability to clearly communicate with internal and external audiences
• Ability to be flexible and work with ambiguity
• Ability to self-direct work with solid problem-solving skills
• Ability to multitask and prioritize
• Ability to work collaboratively
• Embrace a growth mindset
• Highly motivated
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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

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