Clinical Program Consultant - Remote in Western Washington State

UnitedHealth Group•Washington, DC

6d•$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 preventive health and condition management, working with providers and Health Plan staff to improve member health outcomes, close care gaps, and increase performance on state specific quality measures. The Clinical Practice Consultant supports the Medicaid adult population by coordinating, tracking, and improving compliance with quality and regulatory 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 performance, and address barriers to care. This position integrates clinical knowledge, data review, and collaborative problem solving to improve health outcomes for members 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 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 throughout the state of Washington
Access to reliable transportation and & valid US driver's license

Nice To Haves

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)
Experience supporting provider alignment with state Medicaid quality requirements
Experience supporting provider education or quality initiatives
Familiarity with HEDIS measures (e.g. CBP, CHL, FUA,)
Proven comfort working in fast-paced, evolving environments
Proven ability to interpret and translate health policy, guidance, and measure specifications into actionable provider education
Proven solid 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
Proven background in preventive health and condition management
Reside in Pierce, King or Thurston

Responsibilities

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
Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Serves as subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates
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
Identifies population-based member barriers to care, identify local level strategies to overcome barriers and close clinical gaps in care
Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation consistent with state specific measures and technical specifications
Performs population data assessment and disease management using a continuous quality improvement approach and approved clinical practice and disease management guidelines for the pediatric population
Supports health equity and disparity reduction strategies, including culturally responsive outreach and coordination with community-based organizations
Assist in resolving barriers to care such as access, scheduling, or follow-up needs