Clinical Practice Consultant - South Central, VA Markets

UnitedHealth Group•Lynchburg, VA

33d•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 Clinical Practice Consultant is a direct, provider-facing role and is responsible for ongoing clinical management of physician practices in the Health Plan. This position focuses on clinical quality by designing and leading measure-specific initiatives and supporting providers in continuous quality improvement to meet contractual performance requirements. Duties involve developing and managing partnerships with providers, educating providers on quality measures and best practices, analyzing and reporting quality outcomes, medical record review and retrieval, and collaborating with multidisciplinary teams internally and externally to enhance provider performance. This role reports directly to the Associate Director of Clinical Quality within the Health Plan. If you reside within a commutable distance of the South Central VA area, you will have the flexibility to work remotely as you take on some tough challenges. 75%25 in market same day travel to visit providers. This is a Field Based position with a Home-Based Office. 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.

Requirements

5+ years of clinical experience, or other relevant experience
2+ years of quality improvement experience, or other relevant experience
Proficiency in software applications that include, but not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan
Proven commitment to anticipating, understanding, and meeting the needs of internal and external stakeholders
Proven ability to make formal presentations within the context of their role
Proven excellent verbal and written communication skills
Proven ability to use databases and prepare reports as needed
Proven capability of working independently as well as collaboratively within a complex, cross-functional team environment
Up to 75%25 travel required to physician offices, including long travel days (greater than six hours) and travel outside the assigned region
Driver’s license and access to reliable transportation

Nice To Haves

Current unrestricted nursing licensure in Virginia
Experience working in an office environment for Primary Care
Experience working in Medicaid and/or Medicare
Health care and insurance industry experience, including regulatory and compliance
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

Function as a subject matter expert (SME) for quality measures and preventive health topics for Health Plan staff
Support state-specific medical record retrieval as directed by the Quality Leadership
Assist in the development of Standard Operating Procedures, Job Aids, and educational materials for internal training as needed
Serve as a subject matter expert (SME) for assigned HEDIS/State Measures and preventive health topics
Support quality program with tasks including, but not limited to, reviewing medical records and system databases to address open care gaps
Participate in, coordinate, and/or represent the Health Plan at community-based events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs
Seek opportunities to improve operational efficiencies/effectiveness
May be required to perform other tasks to support quality and/or the health plan as needed
Develop strategic partnerships with network providers to assess quality measure trends and to identify opportunities for improvement
Drive measure-specific quality transformation through targeted clinical and coding education and best practices to network providers
Coordinate and conduct remote or onsite medical record audits to evaluate coding, billing, clinical documentation practices, and measure compliance in accordance with regulatory requirements
Deliver constructive, practical feedback and track the intervention through completion to drive quality improvement
Coordinate and lead year-round medical record retrieval, review, and submission for assigned providers
Document and refer providers’ non-clinical/service issues to the appropriate internal parties