Vacancy caducado!
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 coordination of programs aimed toward clinical quality improvement and working with the providers to develop clinically oriented and community-based partnerships in order to increase quality scores based on state-specific quality measures. The Clinical Practice Consultant will work closely with the quality manager to coordinate an interdisciplinary approach to increased provider performance and member adherence to identified preventive and chronic condition screenings and tests. 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. In this role you will both assist contracted providers with meeting quality goals, as well as assisting the quality manager with the development of member facing programs while performing member outreach in the form of telephone, mailed and coordination of clinic days upon request. The goal of the quality team is continuous quality improvement using approved clinical practice guidelines, HEDIS, STARs, CMS, NCQA and other tools. Position reports to the Quality Leadership of the Health Plan.If you are located in New Mexico, you will have the flexibility to work remotely as you take on some tough challenges.Job Components:
Provider and Practice Education, Quality Oriented health Topics
Targeted Quality Improvement
Gaps in Care Closure
Relationship Management, Internal and External
Community Engagement and Interaction
Primary Responsibilities:
Supportseffectivedeploymentofprogramatthepracticelevelthroughstrategicpartnershipswithparticipating practitionersandpracticestaff whileassessingtrendsin qualitymeasuresandidentifyingopportunitiesfor qualityimprovement
Supports efforts withclinicalteamto researchanddesigneducationalmaterials and programsfor members andinpractitioneroffices;servesas liaisonwithkeyvendorssupportingHEDIS/State measures;coordinateswithvendorsto facilitateinitiativesto improveHEDIS/State measurerates
Participates,coordinates,and/orrepresentstheHealthPlanatcommunitybasedorganizationevents,clinicdays, healthdepartmentmeetings,andotheroutreacheventsfocusedonqualityimprovement,memberhealth education,anddisparityprogramsasassigned
Identifiespopulation-basedmemberbarriersto careandworks withtheQMPteamto identifylocallevel strategiesto overcomebarriersandcloseclinicalgapsincare
Coordinatesandperformsonsiteclinicalevaluationsthrough medical/treatmentrecordauditsto determineappropriate codingandbillingpractices,compliancewithqualitymetrics,compliancewithservicedeliveryandquality standards
Educatesprovidersandofficestaffonproperclinicaldocumentation,coding,andbillingpractices,state- mandatedqualitymetricsspecifications,providerprofilingandpayforperformancemeasurement,andmedical recordreviewcriteria
Supportscontinuumofmembercarebyidentifyingmembersinneedof healtheducationand/orservices(case management,etc.)andrefersmembersto theappropriateinternaldepartmentsperpolicy
Documentsandrefersproviders’non-clinical/serviceissuesto theappropriateinternalparties,to include ProviderRelationsandthePlanChiefMedicalOfficer
Ifrequired,supportsstatespecificmedical/treatmentrecordcollectionandabstractionprocessesto driveoptimum measurementandqualitymetricreportingduringambulatorymedicalrecordreview,HEDISdatacollection,or forotherfocusstudiesasdirectedbythePlanQualityVice President
Participatesinorcoordinateswithotherdepartmentprojectsasneeded
Contacts members in an effort to close identified gaps in care
Worksindependentlyandwithinanintegratedteamina highlymatrixedenvironment
Travel up to 75% of the time to meet with Provider Groups
Additionaldutiesasassigned
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.Required Qualifications:
3+ years of service delivery system or managed care setting experience
2+ years of quality improvement experience, or other relevant experience
HEDIS / Medicare / STARS experience
Experience working in Medicaid and/or Medicare in the Managed Care setting
Proven ability to contact members in an effort to close identified gaps in care
Reliable transportation and the ability to travel up to 75% of the time
Currently reside in New Mexico
Preferred Qualifications:
Health care and insurance industry experience, including regulatory and compliance
Experience with utilizing and comparing past data trends and investigating data nuances - including CPT coding and Claims analysis
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 Group’s Telecommuter PolicyAt 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.
Vacancy caducado!