Clinical Practice Consultant - Washington

UnitedHealth Group•Renton, WA

7d•Hybrid

About The Position

The Clinical Practice Consultant is a direct, provider-facing role at UnitedHealthcare, focused on improving clinical quality outcomes through measure-specific initiatives and provider engagement. This role supports continuous quality improvement, including provider education, quality performance monitoring, medical record review, and collaboration across clinical and operational teams to meet contractual and regulatory requirements. Specializing in EPSDT (Early and Periodic Screening, Diagnostic and Treatment) and pediatric preventive care programs, the consultant works with providers and Health Plan staff to improve child wellness, close care gaps, and increase performance on state-specific pediatric quality measures. The position supports the Medicaid pediatric population by coordinating, tracking, and improving compliance with EPSDT requirements in alignment with Washington State Medicaid (Apple Health) and federal guidelines. It involves close collaboration with providers, clinical teams, quality, analytics, and community partners to identify gaps in care, monitor EPSDT performance, and address barriers to care, integrating clinical knowledge, data review, and collaborative problem-solving. The role requires up to 50% anticipated travel throughout Washington State, with flexibility for telecommuting for those located in Washington State.

Requirements

2+ years of experience in Medicaid, managed care, care coordination, or clinical quality
1+ years of experience working with healthcare data (claims, registries, care gaps, or reports)
Intermediate level of knowledge of EPSDT, well-childcare, or pediatric preventive services
Intermediate level of knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Outlook, Word, Excel, and PowerPoint
Willing and able to travel to physician offices locally up to 50% of the time within Washington

Nice To Haves

Associate’s or bachelor’s degree in healthcare, public health, or related field (or equivalent experience)
Current unrestricted RN or Clinical background such as RN, LPN, MA, or equivalent experience
Experience in quality process improvement (lean, six sigma, etc.)
Experience with Washington State Medicaid (Apple Health)
Ability to interpret and translate EPSDT policy, guidance, and measure specifications into actionable provider education
Familiarity with HEDIS pediatric measures (e.g., WCV, CIS)
Demonstrated experience working with pediatric preventive services, EPSDT, or child wellness programs
Knowledge of pediatric screening tools (e.g., developmental, behavioral, social determinants) and referral workflows
Experience supporting provider alignment with state Medicaid pediatric quality requirements
Experience supporting provider education or quality initiatives
Comfort working in fast-paced, evolving environments
Strong communication, organizational, and follow-up skills
Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan

Responsibilities

Support EPSDT program activities and compliance with Washington Medicaid and federal EPSDT requirements through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Educates providers and office staff on proper clinical documentation, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
Advise providers on state‑specific EPSDT periodicity schedules, documentation expectations, and compliance considerations
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
Track EPSDT screenings, well-child visits, and follow-up services. Review claims, encounter data, registries, and supplemental sources for accuracy and gaps. Collaborate with analytics and quality teams to validate EPSDT data
Identify members due or overdue for EPSDT services and assist with outreach initiatives
Collaborates with maternal‑child health, care management, behavioral health, and community outreach teams to address EPSDT referral completion and unmet diagnostic or treatment needs
Supports health equity and disparity reduction strategies specific to pediatric populations, including culturally responsive outreach and coordination with community‑based organizations
Serve as a resource for providers related to EPSDT requirements and documentation
Assist in resolving barriers to care such as access, scheduling, or follow-up needs
Support audits, reporting, and quality improvement activities related to EPSDT