Provider Quality Engagement Consultant - Remote in Kentucky

Job d:

Location:

Lexington-Fayette, Kentucky, United States Salary: $91,700 - $163,700/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

The Provider Quality Engagement Consultant (PQEC) position is responsible for strategically developing provider and community-based partnerships in order to increase quality scores based on health plan priorities. This role will be responsible for ongoing management of provider practice and community education on state specific quality measures. The Provider Quality Engagement Consultant will work closely with the quality director to coordinate an interdisciplinary approach to increased provider performance.

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. This role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools.  

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

This is a field based position where you will travel locally to physician offices within the Commonwealth of Kentucky area, up to 75% of the time.

Primary Responsibilities:

Developing provider partnerships to increase quality scores based on state specific quality measures

Provider education including analysis and review of outcomes, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, and pay for performance initiatives

Uses critical thinking and analyzes provider reports to identify opportunities for preventative care services for members

Serves as the primary point of contact for provider incentive programs

Escalates provider concerns

Participate in providers events, town hall meetings, or collaborate with other external partners in the community or local or state government

Key member of the quality team by supporting:
Quality Performance Improvement Projects (PIPs);
Health Plan or Department initiatives;
Provider education and data collection from providers

Collaborates with Internal & External partners

Maintains Current and Accurate Documentation 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

Educates providers and office staff on proper clinical documentation, coding, and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria

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…