For you, quality counts. As a Clinical Practice Consultant (CPC), you will be responsible for strategically developing clinically oriented provider and community based partnerships in order to increase quality scores based on state specific quality measures. Join us and help guide our efforts to improve the patient experience.
If you are located in the Tucson, AZ area, you will have the flexibility to telecommute* as you take on some tough challenges.
- Responsible for ongoing management of provider practice and community education on state specific quality measures
- Works with provider practices to develop action plans to drive quality improvement • Educates providers and office staff on proper clinical documentation, coding, and billing practices, CMS mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
- Analysis, review, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, and pay for performance initiatives
- Serves as subject matter expert (SME) for assigned Medicaid/Medicare HEDIS / CMS 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 Medicaid/Medicare HEDIS / CMS Measures; consults with vendors to design and implement initiatives to innovate and then improve Medicaid/Medicare HEDIS / CMS Measure rates
- Identifies patient care opportunities and collaborates with physician practices to ensure appropriate member appointments and care
- 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
- 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
- Documents and refers providers' non-clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer by analyzing provider records and maintaining database
- Current, unrestricted RN license in the State of AZ or Bachelor’s level degree or higher
- 2+ years of Healthcare experience
- 2+ years of Medicare / Medicaid experience
- Intermediate level proficiency in Microsoft Excel
- Reliable transportation to travel to physician offices locally up to 75% of the time
- 2+ years of quality improvement experience
- 3+ years clinical experience in a physician practice, outpatient facility or a FQHC
- 2+ years of HEDIS experience
- Health insurance industry experience, including regulatory and compliance
- Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, governing and regulatory agency requirements and the managed care industry
- Ability to handle multiple tasks and competing priorities
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Job Keywords: RN, Registered Nurse, Bachelor's degree, HEDIS, Quality, Quality Improvement, Medicare, Medicaid, FQHC, health care, clinic, provider, clinical, Tuscon, AZ, Arizona, Telecommute, Telecommuter, Telecommuting