Clinical Practice Consultant

UnitedHealth Group • Virginia Beach, VA

271d • $71,600 - $140,600 • 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 equitable. 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 Tidewater area in VA, you will have the flexibility to work remotely as you take on some tough challenges. 75% in market same day travel to visit providers. This is a Field Based position with a Home Based Office.

Requirements

• Current unrestricted nursing licensure required in Virginia
• 5+ years 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
• Ability to travel to physician offices up to 75% of the time to cover assigned region

Nice To Haves

• Bachelor's degree in science or equivalent work experience
• 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

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
• 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

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree