Provider Enablement Consultant

UnitedHealth Group•Phoenix, AZ

6h•$72,800 - $130,000•Remote

About The Position

The Provider Enablement Consultant (PEC) is responsible for the ongoing clinical management and quality oversight of Optum Behavioral Health’s value-based programs. The PEC will be responsible for developing relationships with participating behavioral health providers and facilities, and driving a quality improvement process to improve quality, improve clinical outcomes, increase efficiency and reduce overall benefit expense. The PEC will monitor provider performance and compliance with contractual obligations, provide tools to assist with performance and compliance, and is accountable for driving provider performance improvement. As the single point of clinical contact for a provider, the PEC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within Optum and the participating provider. The PEC must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume facilities/groups and/or providers. This PEC will work closely with Care Advocacy Operations, Affordability, Network Management teams and other relevant departments to affect desired outcomes with the participating provider as it relates to treatment for our membership.

Requirements

Active and unrestricted Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D/Psy.D. level Psychologist, OR Bachelor's level RN (licensure must be in state of residence)
3+ years of post-licensure direct behavioral health clinical experience
1+ years of experience in a managed care setting
1+ years of experience performing analysis, reporting, and data analytics within healthcare, Medicaid, and/or health & human services environment
Intermediate level of proficiency with Microsoft Office (Excel required)

Nice To Haves

Working knowledge of Public Sector benefit plans
Experience identifying performance improvement opportunities and influencing quality metrics
3+ years of Managed Care experience
Ability to balance contractual and clinical considerations
Strong relationship building and influencing skills
Strong written and verbal communication skills
Excellent time management and prioritization skills

Responsibilities

Build and effectively maintain relationships with provider leadership and key clinical staff
Regularly facilitate oversight meetings with providers to monitor, present, and discuss performance
Monitor provider performance on program metrics, quality outcomes and adherence to contract requirements
Identify performance improvement opportunities through analysis of operational data, clinical outcome data and utilization/claims data
Communicate with providers to initiate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with contractual obligations
Initiate and monitor Quality Improvement Plans to drive performance
Conduct provider program audits and provide feedback and results
Support high performing providers such that performance remains at a high level
Provide clinical and care coordination support
Deliver education and training
Interface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement