Provider Enablement Value-Based Care - VBC - Population Health and Clinical Quality Director

UnitedHealth Group • Plymouth, MN

234d • $124,500 - $239,400 • Remote

About The Position

The VBC Population Health and Clinical Quality Director for the Provider Enablement Methods & Data Science team provides clinical expertise and guides the direction of clinical best practice and population health interventions within the Provider Enablement product roadmaps, leads client collaboration meetings, and provides clinical oversight of the methodology behind the products. This position will develop clinical decision-making logic that will be applied across a suite of products that illuminate healthcare costs and clinical quality across the entire clinical enterprise, with particular focus on clinical quality measurement. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

• Nurse Practitioner or Physician Assistant or equivalent with an active, unrestricted license
• 5+ years of experience as a practicing clinician in the United States
• 5+ years of experience in the use and application of claims and clinical (electronic health record) data-based analytics
• 3+ years of experience with healthcare quality measurement in the United States
• Knowledge of Value-Based Care programs and initiatives
• Familiarity with administrative claims data and medical coding systems (i.e., CPT, HCPCS, ICD-9, ICD-10)
• Demonstrated ability in written and verbal communication and presentation skills with clients

Nice To Haves

• Experience participating in, managing or designing Value-Based Care programs and initiatives
• Experience with population health interventions and/or care management workflows
• Experience with, or directly used, any tool within Symmetry Suite or Impact Suite analytic applications
• Interest in or experience with machine learning and/or artificial intelligence methods
• Experience with risk-adjusted quality measures and payment tools
• Experience with clinical data from EMR to optimizing health care solutions (e.g., clinical decision support systems, care management programs)
• Experience networking within your area to build relationships and further business opportunities
• Knowledge and/or experience in cost/utilization measurement, bundled payments, or episode groupers
• Knowledge and/or experience in quality measures (e.g., STARS, HEDIS, State measures)
• Demonstrated ability to develop new analytics to meet market needs
• Proven basic skills using industry-standard data analysis tools such as Microsoft ACCESS, EXCEL, or SQL
• Proven interpersonal skills and ability to work cohesively in a team environment
• Proven organizational skills (e.g., prioritize and manage multiple tasks, meet deadlines, complete complex long-term projects)
• Proven to published in peer-review journals

Responsibilities

• Develop novel healthcare quality measures by staying informed of industry changes and collaborating with internal and external clients and physician consultants
• Leverage clinical expertise to elevate, innovate, and advance healthcare analytic products and consulting projects in value-based care
• Client-facing role will support sales and renewals by engaging with current and prospective clients, offering detailed insights into the clinical logic within the quality product area
• Lead clinical discussions with an external panel of specialty physician consultants to design clinically appropriate quality measures
• Drive innovation in the quality measure space by developing point of care measures and actionable opportunities to support VBC contracts and drive reduction in total cost of care while ensuring best practice
• Ensure AI/ML solutions align with real-world clinical experience of providing patient care and operational considerations to center our products around optimal patient outcomes; provide clinical expertise for these solutions for applications in automating population health interventions and optimization of care management workflows
• Thoroughly research and examine diagnosis, procedure and laboratory codes (e.g., ICD10, CPT, LOINC) with pharmacy claims to establish clinical definitions that drive quality measurement, AI tools, and ML models
• Develop novel methodologies in existing analytics/products and new decision-support applications
• Lead or contribute to efforts to write peer-reviewed publications, white papers, and other dissemination projects that highlight the use of our advanced analytics solutions
• Promote a culture of clinical excellence for the company and its AI/ML and quality-based solutions

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed