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Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation. The focus of the position can be both internal and external, working to improve UHC operational processes, or those conducted by contracted network practitioners and providers. Responsible for the analysis and reporting of member care quality, as defined by state performance measure and/or accreditation requirements, and for the development of plans and programs to support continuous quality improvement.

This role may require travel within the state of North Carolina, Northcentral Region, up to 50% of the time.

If you live in North Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

Scope Summary:

• Relationship Development/Management, Internal and External
• Front Facing Primary Care Provider (Practice) Mentorship
• NC DHHS Standard Plan Ambulatory Care Performance Measures
• Practice Performance Improvement Program 
• Practice Medical Record and Care Gap Closure Assessment and Improvement Action Planning
• Creates individual work products and reviews the work of others
• Develops innovative approaches
• Sought out as expert
• Serves as a leader/ mentor

Primary Responsibilities: 

• Recommend target Practices for engagement, based upon analysis of gap closure opportunities.
• Read and interpret standards/requirements and/or technical specifications (e.g., structure and process, CMS star ratings, URAC, NCQA HEDIS measures, state specific performance measures, CAHPS/member satisfaction specifications, SNP)
• Develop clinically oriented Practice partnerships to foster an increase in state specific clinical quality measure performance. 
• Meet with target Practices face-to-face on a regular basis to establish the organization’s commitment to supporting Practices in their quest to demonstrate quality. 
• Conduct assessment and analysis of Practice workflows, medical record documentation, and methods by which claim and/or encounter data are supplied to UHCCP NC to understand and prioritize opportunities to close gaps in care. 
• Provide Practice education on performance measure specifications and give insight into assigned member/patient compliance and non-compliance, inclusive of UHCCP NC approved clinical practice guidelines, state specific and NCQA HEDIS-defined performance measures.
• Supply Practices with best practice gap closure processes and also demonstrate various UHC tools for tracking gap closure and submitting compliant evidence. 
• Collaborate with Practices to develop an improvement plan, and periodically assess status/mitigate barriers as able.
• Make recommendations or clarify information to assist Practices in closing gaps that are identified
• Work with Practices to develop and/or assist with corrective action plans based on audit findings or customer feedback
• Educate on pay for performance programs, and provide insight into current rate of incentive performance as eligible

You’ll 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.