Provider Quality Engagement Consultant - Remote in Kentucky

UnitedHealth Group•Covington, KY

1d•$91,700 - $163,700•Remote

About The Position

The Provider Quality Engagement Consultant (PQEC) position is responsible for strategically developing provider and community-based partnerships in order to increase quality scores based on health plan priorities. This role will be responsible for ongoing management of provider practice and community education on state specific quality measures. The Provider Quality Engagement Consultant will work closely with the quality director to coordinate an interdisciplinary approach to increased provider performance. Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives. This role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. If you are located in Kentucky, you will have the flexibility to work remotely as you take on some tough challenges. This is a field based position where you will travel locally to physician offices within the Commonwealth of Kentucky area, up to 75% of the time.

Requirements

BA/BS degree in Business, Healthcare Administration, Public Health, Communications, Nursing or related field and/or equivalent education and experience
3+ years of relevant work experience in provider relations, community outreach, consulting, health care, or quality improvement
Intermediate proficiency with MS Project, PowerPoint, and SharePoint
Intermediate proficiency with Excel to include pivot tables, v-lookup and other data manipulation skills
Proven excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
Demonstrated solid problem solving and analytical and skills
Demonstrated ability to influence and work with a wide range of internal and external stakeholders/resources to move projects and programs forward and overcome any challenges
Demonstrated excellent communication skills both written and verbal
Ability to travel up to 75% within the Commonwealth of Kentucky area
Reliable transportation to visit assigned providers
Reside within the Commonwealth of Kentucky area

Nice To Haves

Certified Professional Coder (CPC)
Certified Professional in Healthcare Quality Certification (CPHQ), IHI certificate or Lean background
Experience working with Medicaid population
Experience working with a Managed Care Organization
Experience with HEDIS and NCQA
Self-directed, independent, and proactive with a track record of initiation
Possess solid listening skills, demonstrated by high level of responsiveness and follow through
Comfortable working through ambiguity and is adaptable to change
Understanding of primary care best practices, clinical processes, and process improvement skills
Demonstrated ability to summarize key business learning, and translate into tactical plans and report to executive level management
Demonstrated ability to influence non-direct reports, both internally and externally
Demonstrated ability to make recommendations and implement quality improvement interventions based on results of projects. Converts data into useable information and measures the impact of improvement initiatives
Demonstrated commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques; Open to innovation, creative ideas, will completely re-engineer work processes when needed. Promotes quality focus among others
Uses Critical Thinking
Leverages Our United Culture values of Integrity, Compassion, Relationships, Innovation and Performance internally and in customer commitments

Responsibilities

Developing provider partnerships to increase quality scores based on state specific quality measures
Provider education including analysis and review of outcomes, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, and pay for performance initiatives
Uses critical thinking and analyzes provider reports to identify opportunities for preventative care services for members
Serves as the primary point of contact for provider incentive programs
Escalates provider concerns
Participate in providers events, town hall meetings, or collaborate with other external partners in the community or local or state government
Key member of the quality team by supporting: Quality Performance Improvement Projects (PIPs); Health Plan or Department initiatives; Provider education and data collection from providers
Collaborates with Internal & External partners
Maintains Current and Accurate Documentation
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
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria