The
Clinical Practice Consultant is a direct, provider-facing role, focused on improving clinical quality outcomes through measure specific initiatives and provider engagement. This role partners with providers and internal teams to support continuous quality improvement, including provider education, quality performance monitoring, medical record review, and collaboration across clinical and operational teams to improve outcomes and meet contractual and regulatory requirements.
This position specializes in preventive health and condition management, working with providers and Health Plan staff to improve member health outcomes, close care gaps, and increase performance on state specific quality measures. The Clinical Practice Consultant supports the Medicaid adult population by coordinating, tracking, and improving compliance with quality and regulatory requirements in alignment with Washington State Medicaid (Apple Health) and federal guidelines.
The role works closely with providers, clinical teams, quality, analytics, and community partners to identify gaps in care, monitor performance, and address barriers to care. This position integrates clinical knowledge, data review, and collaborative problem solving to improve health outcomes for members in Washington State.
Up to 50% anticipated travel throughout Washington State. If you are located in
Washington, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Educates providers and office staff on proper clinical documentation, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
- Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
- 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, identify local level strategies to overcome barriers and close clinical gaps in care
- Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
- Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation consistent with state specific measures and technical specifications
- Performs population data assessment and disease management using a continuous quality improvement approach and approved clinical practice and disease management guidelines for the pediatric population
- Supports health equity and disparity reduction strategies, including culturally responsive outreach and coordination with community-based organizations
- Assist in resolving barriers to care such as access, scheduling, or follow-up needs
You9ll 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:- 2+ years of experience in Medicaid, managed care, care coordination, or clinical quality
- 1+ years of experience working with healthcare data (claims, registries, care gaps, or reports)
- Intermediate level of knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
- Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Outlook, Word, Excel, and PowerPoint
- Willing and able to travel to physician offices locally up to 50% of the time throughout the state of Washington
- Access to reliable transportation and & valid US driver9s license
Preferred Qualifications:- Current unrestricted RN or Clinical background such as RN, LPN, MA, or equivalent experience
- Experience in quality process improvement (lean, six sigma, etc)
- Experience with Washington State Medicaid (Apple Health)
- Experience supporting provider alignment with state Medicaid quality requirements
- Experience supporting provider education or quality initiatives
- Familiarity with HEDIS measures (e.g. CBP, CHL, FUA,)
- Proven comfort working in fast-paced, evolving environments
- Proven ability to interpret and translate health policy, guidance, and measure specifications into actionable provider education
- Proven solid communication, organizational, and follow-up skills
- Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan
- Proven background in preventive health and condition management
- Reside in Pierce, King or Thurston
*All Telecommuters will be required to adhere to UnitedHealth Group9s Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you9ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range $72,800 to $130,000 per hour based on full-time employment. This role is also eligible to receive bonuses based on sales performance. We comply with all minimum wage laws as applicable.
