Senior Clinical Practice Performance Consultant

UnitedHealth Group•La Crosse, WI

3d•$91,700 - $163,700•Remote

About The Position

The Senior Clinical Practice Performance Consultant is a senior clinical subject matter expert within Optum Serve Health Services’ Clinical Quality & Patient Safety function. This enterprise-level individual contributor provides consultation across clinical strategy, quality, regulatory alignment, policy and document governance, clinical business development, workforce and care-delivery model design, operational readiness, technology enablement, and continuous improvement. The consultant translates federal and state requirements, contract obligations, accreditation standards, evidence-based practices, and clinical operations into practical, scalable, audit-ready solutions. The role develops and maintains multi-state clinical regulatory infrastructure; evaluates telehealth, telepresenter, mobile, home-based, occupational-health, readiness, and evaluative examination models; and supports collaborative-practice and supervisory governance for regulated clinical professionals. It partners with business development, capture and proposal teams, care delivery, program operations, quality, compliance, legal, credentialing, medical directors, clinical enablement, product, technology, privacy, finance, human capital, environmental and occupational health, and other enterprise functions. The consultant supports established programs and new initiatives by defining clinical service models, evaluating scope-of-practice and licensure requirements, developing and maintaining clinical policies and internal standards, identifying clinical and operational risk, supporting quality and surveillance activities, reviewing training and competency requirements, and advising on implementation and performance improvement. The position leads complex clinical analyses and cross-functional workstreams, influences decisions through evidence and clinical judgment, escalates material risks, and may mentor peers or guide project teams. Final legal, compliance, credentialing, medical, policy, and operational determinations remain with the accountable functions. This is a remote position available anywhere within the United States, with 25% travel. Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy. United States citizenship is required, and the employee must be able to obtain and maintain a suitability determination or eligibility for a Confidential/Secret or Top Secret security clearance.

Requirements

Bachelor’s degree in nursing, healthcare, public health, or healthcare administration.
Active, unrestricted Registered Nurse license; the posting lists MSN, BSN, RN, NP.
At least 8 years of progressive clinical, healthcare operations, quality, regulatory, program-development, or consulting experience.
Significant experience interpreting and applying federal and state healthcare requirements, professional-practice standards, clinical policy, or accreditation requirements.
Experience developing, reviewing, or implementing clinical policies, SOPs, workflows, standards, or quality-management documents.
Experience evaluating clinical scope of practice, licensure, delegation, supervision, credentialing, or professional qualifications.
Experience leading complex, cross-functional clinical initiatives in a matrixed organization.
Demonstrated ability to synthesize complex clinical, regulatory, contractual, and operational information into practical recommendations.
Demonstrated experience communicating with senior leaders, clinical subject matter experts, operational teams, and nonclinical stakeholders.
Advanced proficiency with Microsoft Word, Excel, PowerPoint, Teams, and SharePoint.
Ability to manage multiple high-priority assignments with competing deadlines and incomplete or evolving information.
United States citizenship.
Ability to obtain and maintain a suitability determination or eligibility for a Confidential/Secret or Top Secret security clearance.
Ability to travel 25%.

Nice To Haves

Master of Science in Nursing, healthcare administration, public health, business administration, or a related advanced degree.
Executive MBA or other advanced business, strategy, or healthcare leadership education.
10 or more years of progressive clinical and healthcare leadership experience.
Experience in federal healthcare, government contracting, military health, Veterans’ health, public health, occupational health, or distributed national care delivery.
Experience with RFI/RFP responses, capture activities, proposal development, clinical solutioning, Quality Control Plans, or post-award transition.
Experience with clinical governance, Joint Commission accreditation, High Reliability Organization implementation, quality improvement, or patient-safety systems.
Experience designing innovative workforce and supervision models across multiple jurisdictions.
Experience developing multi-state regulatory matrices, collaborative or supervisory agreement frameworks, telehealth and telepresenter models, or enterprise clinical governance tools.
Experience with telehealth, mobile clinical services, occupational-health programs, medical-disability examinations, readiness programs, or episodic-care models.
Experience evaluating electronic health records, clinical technology, documentation systems, or digital clinical workflows.
Project-management, process-improvement, quality, compliance, legal-nurse-consulting, or healthcare-executive credentials.
Experience mentoring clinical professionals or onboarding senior clinical consultants.

Responsibilities

Provide senior-level clinical consultation for OSHS programs, enterprise initiatives, new service lines, and strategic growth opportunities.
Evaluate clinical models for safety, quality, regulatory alignment, contractual compliance, operational feasibility, scalability, and workforce readiness.
Develop and maintain enterprise clinical governance architecture, including governance charters, internal standards, regulatory crosswalks, gap-assessment frameworks, evidence requirements, decision pathways, accountability structures, and implementation guidance.
Translate complex clinical and regulatory requirements into practical standards for program leadership, operations, and frontline implementation.
Identify enterprise-level clinical gaps, inconsistencies, and opportunities for standardization; apply High Reliability Organization principles to decision-making, risk identification, and continuous improvement.
Serve as the clinical subject matter expert for RFIs, RFPs, contract modifications, capture activities, solutioning sessions, and new-business development.
Interpret solicitation and contract requirements to define clinical services, care modalities, workflows, staffing models, professional qualifications, supervision structures, and quality requirements.
Conduct clinical gap and capability analyses; develop or review clinical narratives, staffing assumptions, qualification matrices, scope-of-service descriptions, transition plans, readiness requirements, and implementation strategies.
Contribute to quality plans, clinical metrics, audit methodologies, corrective-action pathways, and performance-monitoring structures; identify clinical assumptions, dependencies, risks, cost drivers, and implementation requirements.
Research and assess federal and state requirements affecting licensed professionals, unlicensed assistive personnel, telehealth, mobile care, occupational health, home-based services, and other care-delivery models.
Develop and maintain scope-of-practice standards and reference tools; evaluate permitted and prohibited functions, supervision and delegation rules, documentation expectations, competency requirements, and jurisdiction-specific limitations.
Assess proposed staffing and workforce models against practice acts, board rules, federal authorities, contract requirements, credentialing standards, and internal policies; advise on compact participation, federal exceptions, telehealth licensure, OCONUS considerations, and program-specific authorization.
Develop, evaluate, and maintain collaborative-practice, supervisory, delegation, and clinical-oversight frameworks; assess state-specific agreement, filing, notification, covering-practitioner, physician-availability, quality-review, and documentation requirements.
Maintain regulatory matrices, quick-reference guides, decision tools, and state-specific implementation resources with source standards, review cadence, change tracking, and validation pathways; escalate unresolved scope, licensure, credentialing, supervision, or delegation risks.
Lead or support research, drafting, review, revision, standardization, and maintenance of clinical policies, procedures, standards, SOPs, work instructions, protocols, job descriptions, forms, and implementation tools.
Ensure clinical documents reflect evidence-based practice, professional standards, applicable requirements, accreditation expectations, contract obligations, and operational workflows; coordinate interdisciplinary review and support document control, approval, publication, archival, and periodic review.
Maintain traceability between source requirements, clinical decisions, approved standards, training, workflows, and audit tools; identify conflicting, duplicative, outdated, or unsupported documents and recommend remediation.
Monitor and analyze federal and state healthcare requirements, professional-practice standards, public-health guidance, accreditation expectations, pending legislation, proposed regulations, board actions, compact developments, and emerging standards.
Conduct targeted research using authoritative primary sources; develop impact assessments distinguishing explicit requirements, interpretation, operational implications, risks, and recommended actions.
Translate regulatory and clinical changes into recommended policy, training, workflow, quality-control, and operational changes; document evidence, citations, effective dates, jurisdictional limitations, and unresolved questions.
Identify clinical, regulatory, operational, workforce, and patient-safety risks associated with current and proposed services; conduct or support risk assessments, gap analyses, root-cause analyses, incident reviews, failure-mode evaluations, and corrective-action planning.
Evaluate audit findings, documentation trends, complaints, adverse events, near misses, performance metrics, and operational variation; recommend risk controls, escalation pathways, monitoring methods, competency requirements, and corrective or preventive actions.
Support development of audit criteria, surveillance tools, readiness assessments, clinical dashboards, and quality indicators; document, assign, escalate, and monitor identified risks through resolution.
Design or evaluate workforce models for fixed-site, mobile, virtual, embedded, event-based, surge, occupational-health, and home-based services; define roles, qualifications, staffing ratios, supervision, escalation coverage, competency requirements, and operational boundaries.
Assess personnel suitability and workforce models for patient safety, legal scope, operational feasibility, workforce availability, cost, and scalability; support development of job descriptions, role profiles, competency frameworks, interview criteria, resume-review standards, and onboarding requirements.
Evaluate telehealth, telepresenter, remote-supervision, and hybrid service models, including clinical appropriateness, examination limitations, qualifications, documentation, technology dependencies, escalation pathways, and in-person-care requirements.
Differentiate clinical requirements by program purpose and legal structure, including treatment, occupational health, medical surveillance, disability evaluation, readiness assessment, triage, advisory, and administrative examination models.
Evaluate task-level authority and competency requirements for ancillary procedures and diagnostic services, including phlebotomy, electrocardiography, spirometry and pulmonary-function testing, ankle-brachial index testing, medication-related activities, specimen handling, and telepresenter-assisted examinations.
Define clinical learning requirements for programs, roles, policies, workflows, and regulatory changes; clinically review onboarding, sustainment, remediation, and annual competency content.
Develop or contribute specialized clinical subject-matter content; establish competency criteria, validation methods, assessor qualifications, reassessment requirements, and documentation expectations.
Evaluate training effectiveness and recommend updates based on audits, operational feedback, incidents, regulatory changes, and performance trends.
Provide clinical consultation for occupational health, medical surveillance, workforce health, infection prevention, exposure response, vaccination, fitness-for-duty, and employee-safety programs.
Evaluate workplace clinical protocols, employee-health workflows, medical-screening requirements, exposure risks, and field-safety considerations.
Establish or evaluate clinical standards and controls for medications, vaccines, laboratory and point-of-care testing, medical equipment, supplies, specimen handling, infection prevention, temperature control, emergency resources, and regulated medical waste.
Assess clinical and workforce risks of mobile, home-based, remote, and field operations, including home-entry protocols, lone-worker safety, environmental hazards, emergency communication, transportation and vehicle liability, equipment and supply security, infection control, accompaniment criteria, and field readiness.
Collaborate with Environmental and Occupational Health, Operations, Legal, Compliance, and program leadership on risk mitigation and implementation.
Define clinical, documentation, safety, privacy, quality, and workflow requirements for electronic health records, clinical platforms, digital tools, telehealth solutions, and emerging technologies; translate clinical operations into functional business and system requirements.
Lead or support development of clinical and information-governance requirements for electronic health records and related platforms, including longitudinal record management, diagnosis and problem-list reconciliation, continuity of care, role-based access, patient versus employer visibility, occupational-health record separation, PHI controls, audit trails, clinical decision support, and contract-specific reporting.
Participate in system selection, requirements development, workflow mapping, user-acceptance planning, implementation, and optimization; evaluate technology for safe care, regulatory compliance, contractual reporting, clinical governance, and auditability.