Clinical Practice Performance Consultant - Remote in MD

Job d:

Location:

Columbia, Maryland, United States Salary: $72,800 - $130,000/year

Job Area:
Medical & Clinical Operations Company:
United Health Group At United Healthcare, 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 optimized. Ready to make a difference? Join us to start Caring.

Connecting. Growing together

Position is responsible for strategically developing clinically oriented provider and community-based partnerships in order to increase HEDIS quality scores and state specific quality measures. This role will be responsible for ongoing management of provider practice quality measures and HEDIS medical record collection to support NCQA accreditation compliance.

The Clin Practice Perf Consultant will work closely with the Quality Field Operations manager to coordinate an interdisciplinary approach to increased provider performance in accordance with NCQA and State requirements.  Focused provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level.
Through HEDIS documentation collection and review, monitoring, measuring, and reporting on key metrics, the Clin Practice Perf Consultant assists providers in meeting quality standards, state contractual requirements and pay for performance initiatives.

Positions in this function drive clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO mgrs, Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with a goal of improving health, well-being, quality and practice performance while reducing medical costs.  Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closure, coding accuracy, facilitating effective education and reporting, effective super utilizer engagement (e.g., members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support.  

These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions and improve their outcomes.

Generally work is self-directed and not prescribed

Works with less structured, more complex issues

Serves as a resource to others

Job Scope and Leveling Guidelines:  Assesses and interprets customer needs and requirements

Identifies solutions to non-standard requests and problems

Solves moderately complex problems and/or conducts moderately complex analyses

Works with minimal guidance; seeks guidance on only the most complex tasks

Translates concepts into practice

Provides explanations and information to others on difficult issues

Coaches, provides feedback, and guides others

Acts as a resource for others with less experience

If you are located in Maryland, you will have the flexibility to work remotely
* as you take on some tough challenges.

Primary Responsibilities:

Serves as subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates

Participates, coordinates, and/or represents the Health Plan at community- based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned

Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care Reports individual member quality of care concerns or trends of concern to the Quality Manager Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards

Assists contracted providers with analyzing…