Clinical Practice Consultant- Nurse - Wisconsin

UnitedHealth Group • Milwaukee, WI

31d • Remote

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The CPC will focus on tasks that occur in accordance with State, CMS or other requirements as applicable. Position responsible for direction and guidance on provider-focused, clinical quality improvement and management programs. The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. Solves moderately complex problems and/or conducts moderately complex analyses.
Position reports to the Quality Leadership of the Health Plan
This is a telecommute role with up to 75%25 of local travel
If you are live in WI, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

• Current unrestricted RN in the state of WI
• 5+ years of clinical experience, preferably with Behavioral Health
• 2+ years of quality improvement experience
• 2+ years of experience in one or more of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
• Demonstrated ability to travel to physician offices locally up to 75%25 of their time
• Demonstrated ability to make formal presentations within the context of their role
• Demonstrated ability to use databases and prepare reports as needed
• Intermediate Microsoft skill including Word, Excel, and PowerPoint

Nice To Haves

• Certified Professional in Healthcare Quality Certification (CPHQ), IHI certificate or Lean background
• Experience working in Medicaid and/or Medicare
• Health care and insurance industry experience, including regulatory and compliance
• Multilingual candidates

Responsibilities

• Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
• Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS/State Specific quality measures for provider and staff education during field visits. Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
• Serves as subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; Complete data analysis for measures and providers to determine progress and root causes of performance
• Lead multidisciplinary teams to complete project tasks
• Serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates
• Participates, coordinates, and/or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
• Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
• Reports individual member quality of care concerns or trends of concern to the Health Plan Quality Director
• Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards
• Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
• Based on medical record audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed