Description

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Clinical Practice Consultant (CPC) will be responsible for strategically developing clinically oriented provider and community-based partnerships, education, and action plans to increase quality scores based on HEDIS, NCQA, and state specific quality measures. This role will be responsible for ongoing management of provider practice quality measures. Through HEDIS documentation collection and review, monitoring, measuring, and reporting on key metrics, the Clinical Practice Consultant assists providers in meeting quality standards, state contractual requirements and pay for performance initiatives.

This is an Idaho-based role and you will have the flexibility to work remotely* as you take on this challenging and rewarding work.

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

Primary Responsibilities:

• Responsible for ongoing management of provider practice and community education on HEDIS, NCQA, and state specific quality measures
• Work with provider practices to develop action plans to drive quality improvement
• Educate 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
• Serve as subject matter expert (SME) for assigned Medicaid/Medicare HEDIS / CMS measures, preventive health topics; lead efforts with clinical team to research and design educational materials for use in practitioner offices; serve as liaison with key vendors supporting Medicaid/Medicare HEDIS / CMS Measures; consult with vendors to design and implement initiatives to innovate and then improve Medicaid/Medicare HEDIS / CMS Measure rates
• Identify patient care opportunities and collaborate with physician practices to ensure appropriate member appointments and care
• Coordinate and perform 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
• Investigate 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
• Document and refer 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
• Other duties as assigned

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 development for other roles you may be interested in.

Required Qualifications:

• 3+ years of Clinical experience in a physician practice, outpatient facility or a FQHC
• 2+ years of quality improvement experience
• 2+ years of Medicare / Medicaid experience
• Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Reliable transportation to travel to physician offices locally up to 75% of the time
• Resident of Idaho

Preferred Qualifications:

• Current, unrestricted RN license in the State of ID
• 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

*All employees working remotely will be required to adhere to UnitedHealth Group's 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, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24 - $43 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.