Job Description

Clinical Practice Consultant

At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing Together.

The Clinical Practice Consultant is a direct, provider-facing role and is responsible for ongoing clinical management of physician practices in the Health Plan. This position focuses on clinical quality by designing and leading measure-specific initiatives and supporting providers in continuous quality improvement to meet contractual performance requirements. Duties involve developing and managing partnerships with providers, educating providers on quality measures and best practices, analyzing and reporting quality outcomes, medical record review and retrieval, and collaborating with multidisciplinary teams internally and externally to enhance provider performance. This role reports directly to the Associate Director of Clinical Quality within the Health Plan.

If you reside within a commutable distance of the Northern VA area, you will have the flexibility to work remotely* as you take on some tough challenges. 75% in market same day travel to visit providers. This is a Field Based position with a Home Based Office.

Primary Responsibilities:

• Operational Team Support
  • Function as a subject matter expert (SME) for quality measures and preventive health topics for Health Plan staff
  • Support state-specific medical record retrieval as directed by the Quality Leadership
  • Assist in the development of Standard Operating Procedures, Job Aids, and educational materials for internal training as needed
  • Serve as a subject matter expert (SME) for assigned HEDIS/State Measures and preventive health topics
  • Support quality program with tasks including, but not limited to, reviewing medical records and system databases to address open care gaps
  • Participate in, coordinate, and/or represent the Health Plan at community-based events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs
  • Seek opportunities to improve operational efficiencies/effectiveness
  • May be required to perform other tasks to support quality and/or the health plan as needed
• Provider Management Support
  • Develop strategic partnerships with network providers to assess quality measure trends and to identify opportunities for improvement
  • Drive measure-specific quality transformation through targeted clinical and coding education and best practices to network providers
  • Coordinate and conduct remote or onsite medical record audits to evaluate coding, billing, clinical documentation practices, and measure compliance in accordance with regulatory requirements
  • Deliver constructive, practical feedback and track the intervention through completion to drive quality improvement
  • Coordinate and lead year-round medical record retrieval, review, and submission for assigned providers
  • Document and refer providers non-clinical/service issues to the appropriate internal parties

Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current unrestricted nursing licensure in Virginia
• 5+ years of clinical experience, or other relevant experience
• 2+ years of quality improvement experience, or other relevant experience
• Proficiency in software applications that include, but not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan
• Proven commitment to anticipating, understanding, and meeting the needs of internal and external stakeholders
• Proven ability to make formal presentations within the context of their role
• Proven excellent verbal and written communication skills
• Proven ability to use databases and prepare reports as needed
• Proven capability of working independently as well as collaboratively within a complex, cross-functional team environment
• Ability to travel to physician offices up to 75% of the time to cover assigned region
• Drivers license and access to reliable transportation

Preferred Qualifications:

• Bachelors degree in science or equivalent work experience
• Experience working in Medicaid and/or Medicare
• Health care and insurance industry experience, including regulatory and compliance
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry

*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy.

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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