Field Sr. Clinical Practice Consultant - Northcentral NC - 2198931
At UnitedHealthcare, we’re 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.
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.
- 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
- 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.
Years of post-high school education can be substituted/is equivalent to years of experience
- 4+ years of clinical experience, or other relevant experience (clinical quality)
- 2+ years of quality improvement experience (chart review, HEDIS rate improvement, etc.) or other relevant experience
- Experience working with a managed care provider network or in a practice office setting
- Experience working in Medicaid and/or Medicare
- 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
- Intermediate level Microsoft office
- Willing or ability to travel 50% of the time within the assigned region of NC
- Current unrestricted RN licensure
- Health care and insurance industry experience, including regulatory and compliance
- Medical Coding knowledge / training
- Proven presentation skills (WebEx, Power Point)
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves 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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.