Clinical Program Consultant - Remote in Western Washington State

UnitedHealth Group•Washington, DC

4h•$72,800 - $130,000•Remote

About The Position

The Clinical Practice Consultant is a direct, provider-facing role, focused on improving clinical quality outcomes through measure specific initiatives and provider engagement. This role partners with providers and internal teams to support continuous quality improvement, including provider education, quality performance monitoring, medical record review, and collaboration across clinical and operational teams to improve outcomes and meet contractual and regulatory requirements. This position specializes in behavioral health activities. The Clinical Practice Consultant supports the Medicaid population by coordinating, tracking, and improving compliance with behavioral health requirements in alignment with Washington State Medicaid (Apple Health) and federal guidelines. The role works closely with providers, clinical teams, quality, analytics, and community partners to identify gaps in care, monitor behavioral health performance, and address barriers to care. This position integrates clinical knowledge, data review, and collaborative problem‑solving to improve health outcomes for children and adolescents.

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 behavioral health, pediatric, adolescent or adult 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%25 of the time within Washington
Access to reliable transportation and valid US driver’s license

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 behavioral health policies, guidance, and measure specifications into actionable provider education
Familiarity with behavioral health HEDIS measures
Knowledge of behavioral health 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 behavioral health activities and compliance with Washington Medicaid and federal behavioral health 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 behavioral health 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
Identify members due or overdue for behavioral health services and assist with outreach initiatives
Collaborates with maternal‑child health, care management, behavioral health, and community outreach teams to address unmet behavioral health diagnostic or treatment needs
Supports health equity and disparity reduction strategies specific to Medicaid populations, including culturally responsive outreach and coordination with community‑based organizations
Serve as a resource for providers related to behavioral health 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 behavioral health