At UnitedHealthcare, we’re dedicated to transforming the healthcare landscape by creating healthier communities and eliminating obstacles to high-quality care. The work you undertake here will positively impact millions of lives. Join us in shaping a healthcare system that is more responsive, affordable, and equitable. Are you ready to make a meaningful difference? Let’s embark on a journey ofCaring. Connecting. Growing together.

In the role of Clinical Practice Consultant (CPC), you will play a pivotal part in fostering clinically-based partnerships with providers and community organizations. Your main objective will be to enhance quality scores through strategic education and action plans tailored to HEDIS, NCQA, and state-specific quality measures. You will oversee the continuous management of provider practice quality metrics and facilitate HEDIS documentation collection and review. Additionally, you’ll monitor, measure, and report on essential metrics to support providers in achieving quality standards, meeting state contractual obligations, and succeeding in pay-for-performance initiatives.

If you’re located in Idaho, you will have the convenience of working remotely while taking on various challenges that contribute to our mission.

**Key Responsibilities:**

– Manage ongoing education for provider practices and communities regarding HEDIS, NCQA, and state-specific quality measures.
– Collaborate with provider practices to develop and implement effective action plans aimed at enhancing quality improvement.
– Educate providers and their staff on accurate clinical documentation, coding, billing practices, and CMS-mandated quality metrics to facilitate quality improvement.
– Analyze and report on key metrics assisting providers in satisfying quality standards and fulfilling state contractual requirements and pay-for-performance initiatives.
– Act as a subject matter expert (SME) on assigned Medicaid/Medicare HEDIS/CMS measures and preventive health topics; lead clinical team efforts to create educational resources for practitioner offices; liaise with key vendors and consult with them on innovative initiatives to improve Medicaid/Medicare HEDIS/CMS measure rates.
– Identify opportunities for patient care enhancement and partner with physician practices to secure appropriate member appointments and care.
– Coordinate and carry out onsite clinical assessments through medical record audits to confirm compliance with coding and billing practices, quality metrics, and service delivery standards.
– Investigate and document gaps in clinical documentation impacting rate calculations, provide feedback for resolution, and monitor issues to completion.
– Document and report any non-clinical or service-related issues encountered by providers to relevant internal stakeholders, including Provider Relations and the Plan Chief Medical Officer.
– Perform additional duties as required.

You will be recognized and rewarded for your contributions in an environment designed to challenge you while providing clear pathways to succeed in your role, including opportunities for development in other areas of interest.

**Required Qualifications:**

– A minimum of 3 years of clinical experience in a physician practice, outpatient facility, or FQHC.
– At least 2 years of experience in quality improvement.
– A minimum of 2 years of experience with Medicare/Medicaid.
– Proficiency in essential software such as Microsoft Word, Excel, and PowerPoint.
– Reliable transportation for local travel to physician offices, approximately 75% of the time.
– Must be a resident of Idaho.

**Preferred Qualifications:**

– Valid, unrestricted RN license in the State of Idaho.
– 2+ years of experience with HEDIS.
– Experience in the health insurance industry with knowledge of regulatory and compliance standards.
– Insight into clinical standards of care, preventive health guidelines, HEDIS measures, and the managed care industry.

As a remote employee, you will be expected to adhere to UnitedHealth Group’s Telecommuter Policy.

The annual salary for this position ranges between $71,600 and $140,600, contingent upon full-time employment. Compensation depends on various factors, including local labor market conditions, education, work experience, and certifications. UnitedHealth Group complies with all applicable minimum wage laws. Alongside your salary, you’ll benefit from a comprehensive benefits package, incentive programs, equity stock purchase options, and 401k contributions (subject to eligibility criteria). Regardless of where or when you start your career with UnitedHealth Group, you’ll discover a broad array of benefits and incentives.

*At UnitedHealth Group, our mission is to empower people to live healthier lives and enhance the health system for everyone. We believe in equitable health opportunities for all individuals, irrespective of race, gender, sexuality, age, location, or income. We recognize ongoing barriers to health—especially among marginalized communities—and are committed to addressing these disparities to improve health outcomes—an essential aspect of our mission.*

*UnitedHealth Group is an Equal Employment Opportunity employer. Qualified applicants will be given consideration for employment without regard to race, national origin, age, color, sex, sexual orientation, gender identity, disability, or veteran status, or any other characteristic protected by law.*

*UnitedHealth Group is a drug-free workplace. All candidates must pass a drug test to begin employment.*