Clinical Practice Performance Consultant

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.

The Clinical Practice Performance Consultant develops relationships with provider partners to monitor, influence and advance their abilities to deliver improved member outcomes.

This role works with their Director or Manager to ensure that contracted providers are engaged with the health plan and members are receiving high-quality health services that meets their needs. Clinical Practice Performance Consultants are assigned to a portfolio of ACO’s, Community-based Primary Care Physicians, Specialists, Acute or Post-Acute providers to manage based on needed engagement. The Clinical Practice Performance Consultant should work with assigned provider portfolio to identify performance opportunities, develop their capabilities and, as applicable, innovate existing care delivery shifting from fee for service through the value realization continuum of shared savings to shared risk arrangements.

Primary Responsibilities:

• Serves as liaison to Providers and is responsible to develop, foster and maintain relationships with contracted Providers and office staff to ensure Provider adherence to contractual requirements
• Understand, determine role & accountability, and successfully Implement the organization’s business objectives related to provider engagement to achieve revenue, affordability, provider engagement and satisfaction targets
• Accountable to successful implementation and achieving results of Provider Incentive programs
• Work with Director or Manager to develop reports of actionable data for each provider to stratify and then prioritize members for care management outreach (related to quality, risk score & utilization management)
• Properly engage, orient and onboard providers (after contracted), to effectively introduce them to participation requirements and procedures
• Engage provider partners to adopt technology tools and applications to simplify and digitize their experience
• Develop and implement process improvement specific to provider practice to achieve accountable care goals
• Collaborate with care coordination teams to effectively address immediate and emergent member needs
• Collaborate with network contracting regarding network changes, terminations, deficiencies, and other contract modifications
• Collaborate with provider call services and internal stakeholder departments to identify and resolve provider issues implementing pro-active solutions to complaints or issues

Working with contracted providers, the Clinical Practice Performance Consultant daily activities consist of:

• Assess capabilities and drive improved population health activities
• Monitor, strategize and implement improvement opportunities around key cost, utilization, and quality metrics
• Share actionable data and make recommendations for improved member care basis on this data
• Conduct training and education to new & existing providers as needed, including providing access to education modules
• Seamlessly adopt new technology tools and solutions that support quality improvement
• Performs other duties as requested by management

Required Qualifications:

• 3+ years of combined experience with improving clinical quality and/or health care analytics with population health programs, ambulatory care setting, provider practices
• Experience interpreting and utilizing clinical data, measuring outcomes in healthcare and using data to drive change
• Experience presenting to and collaborating with providers and clinical staff, practice managers
• Experience leading groups and solid presentation skills
• Knowledge and/or experience with Medicare STAR Ratings, HEDIS Measures, Medical Coding and Documentation
• Intermediate+ level proficiency with Microsoft Office Skills with Word, Excel, Outlook and PowerPoint
• Proven solid relationship building skills with internal and practice teams to drive goal alignment
• Proven solid interpersonal skills
• Reliable transportation and the ability to travel locally up to 50% of the time with the Shreveport, Monroe, and Central LA surrounding areas

Preferred Qualifications:

• 4+ years of experience with working with Medicare Advantage providers
• Managed care and/or experience dealing with hospitals, physicians and/or ancillary providers
• Project management experience
• Demonstrated proficiency with Microsoft Office applications for the creation of reports and presentations
• Proven negotiation and influential ability
• Proven solid planning/organizational skills
• Proven oral/written communication skills
• Demonstrated solid judgment

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.