Clinical Practice Performance Consultant - WA Market

UnitedHealth Group•Seattle, WA

10d•$72,800 - $130,000•Hybrid

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. This role is responsible for provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, and to proactively identify performance improvement opportunities through analysis and discussion with subject matter experts. This position does not entail any direct member care nor does any case management occur. (with the exception of participating in health fairs and/or health screenings where member contact could occur)

Requirements

5+ years of healthcare industry experience
3+ years of experience working for a health plan and/or for a provider's office
1+ years of STARs experience
Willing or ability to travel up to 75%25 locally
Proven solid communication and presentation skills
Proven solid relationship building skills with clinical and non-clinical personnel

Nice To Haves

Consulting experience
Experience in managed care working with network and provider relations/contracting
Medical/clinical background
Solid knowledge of electronic medical record systems
Solid knowledge of the Medicare market
Knowledge base of clinical standards of care, preventive health, and Stars measures
Proven solid problem-solving skills
Proven solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Microsoft Office specialist with proven exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills required

Responsibilities

Program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy
Work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results
Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider incentive programs for health plan
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation Training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems
Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Provide suggestions and feedback to Optum and health plan
Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures