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Provider Quality Engagement Consultant (CPC) - Minnetonka, MN

Company: UnitedHealth Group
Location: Minnetonka
Posted on: January 17, 2022

Job Description:

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
The clinical practice consultant (CPC) is responsible for strategically developing provider partnerships to improve performance on quality metrics aligned with regulator and health plan priority areas. CPCs are responsible for ongoing management of provider practice education on quality measures and improvement opportunities. They work closely with the quality director to coordinate an interdisciplinary approach to support provider performance improvement. CPCs analyze quality measures at the provider and practice level, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives. CPCs assist contracted providers with analyzing member care, trending quality measures, and developing action plans to support continuous quality improvement in alignment with approved clinical practice guidelines, evidence-based care standards, NCQA, CMS, and other resources.
Primary Responsibilities:

  • Supports effective deployment of programs 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

  • Designs practice level quality transformation through targeted clinical education and approved materials related to quality measures for provider and staff education during field visits or virtual meetings

  • Serves as subject matter expert (SME) for assigned quality measures, preventive health topics; leads efforts with clinical teams to research and design educational materials for use in practitioner offices

  • Participates, coordinates, and/or represents the health plan at community events, clinic days, health department meetings, and other events focused on quality improvement, member health education, and disparity programs as assigned

  • Identifies population-based member barriers to care and works with the quality team to identify local level strategies to overcome barriers and close clinical gaps in care

  • Reports individual member quality of care concerns or trends of concern to the health plan quality director

  • 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. Based on medical record audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement

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

  • Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation

  • If required, supports medical record collection and abstraction processes for performance measure reporting, ambulatory medical record reviews, or other focus studies as directed by the plan quality director

  • Supports quality improvement program studies with work that ranges from accessing and analyzing provider records, maintaining databases, and researching to identify members' encounter history
    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:

    • 5+ years HEDIS, CAHPS and other health plan quality metrics experience

    • 5+ years health plan quality improvement operations experience

    • 5+ years of clinical quality improvement experience

    • Project management experience

    • Reliable transportation

    • Intermediate experience in a Windows environment, including proficiency in Microsoft Word, PowerPoint, Outlook

    • Advanced Excel skills experience to include manipulating data, creating pivot table, understanding function and calculations

    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
      Preferred Qualifications:

      • Possesses a Bachelor's or Master's degree

      • Unrestricted RN license in the state of Minnesota

      • Experience with Medicaid programs and products

      • CPHQ, Six Sigma or other quality improvement/process improvement certification

      • Strong analytical skills, including design of data collection, analysis and measurement of effectiveness of programs

      • Experience in tracking, planning projects, working with large data sets and making data-driven analytical decisions

      • Excellent written and verbal communication skills

      • Ability to work autonomously and be self-motivated

      • Candidates must be possess excellent verbal communication skills, as well as active listening and problem-solving skills

      • Must be able to read and interpret reports, as well as explain reports to others
        UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
        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)
        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: Clinical Practice Consultant, Performance Improvement Consultant, Clinical, Quality, HEDIS, Quality Improvement, Medicaid and Medicare, Minnetonka, MN, Minnesota

Keywords: UnitedHealth Group, Minnetonka , Provider Quality Engagement Consultant (CPC) - Minnetonka, MN, Professions , Minnetonka, Minnesota

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