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Clinical Practice Consultant - Charlotte, NC - Remote




Charlotte, North Carolina, United States

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position is responsible for strategically developing and managing clinically oriented provider and community-based partnerships in order to meet requirements of the Advanced Medical Home (AMH) program based on state specific guidelines. This role will be responsible for monitoring and providing ongoing oversight of the: AMH Tier 3 program requirements of provider practices and AMH quality improvement support activities with all AMH providers. This role will work in concert with the Local Health Department (LHD) Clinical Practice Consultants.

The Clinical Practice Consultant will work closely with the Health Plan Clinical Leadership to coordinate an interdisciplinary approach to increase provider and program performance. This position will guide practices in achieving AMH quality improvement support activities and AMH Tier 3 program requirements through: oversight, performance monitoring and support; relationship management & engagement; education; and quality improvement. This position is accountable for driving practice progress toward desired transformational change and performance improvement, while meeting AMH program expectations outlined by the state. Position reports to the AMH Transformation Director.

The Clinical Practice Consultant will be assigned to a specified Medicaid region within North Carolina. This is a work from home / telecommute position when not in the field but may also require travel to State sponsored meetings.

The Advanced Medical Home program was developed by NC DHHS as the primary vehicle for delivering care management as the state transitions to Medicaid managed care and includes Tier 1, Tier 2 and Tier 3 providers. The AMH program builds on the Carolina ACCESS program. This position will focus on all AMH Tiers.

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

Primary Responsibilities:

  • Drives execution of clinical practice transformation by overseeing timely and successful deployment of AMH program
  • Provide oversight and performance evaluation through continuous monitoring and analysis of AMH Program and Quality Program requirements and development of strategies based on performance analysis
  • Utilize monitoring, trending and performance improvement strategies to review progress of AMH providers, including specific Tier 3 requirements as defined by the State, and ensure the practice is accountable for successful implementation
  • Provide ongoing support and develop recommended actions and best practices to assist the practice in achieving contractual requirements
  • Regularly facilitate efficient, effective meetings with the practice to monitor, present, and discuss progress towards program requirements
  • Build and effectively maintain relationships with the practice leadership and key clinical influencers actively involved in practice transformation through strategic partnerships
  • Facilitates and participates in multi-disciplinary Joint Operational Committee meetings with external care management partners
  • Serve as liaison and clinical resource using proven interpersonal and collaboration skills to foster relationships and maintain communication with multiple disciplines (e.g. Clinically Integrated Networks (CINs), internal UHC teams, external stakeholders, and other partners as appropriate)
  • Consult and partner with internal UHC matrix partners and the practice to identify organizational and structural challenges hindering achievement of desired program outcomes
  • Cross-collaborate on any identified or ongoing practice needs that require the involvement of a subject matter expert
  • Provide education to promote quality and cost-effective outcomes around, but not limited to: Quality program and metrics, AMH Tier 3 program requirements – including Tier 3 progression, dissemination of the latest information on effective practices, and utilization of tools and resources to meet needs of the population (e.g. best practice guidelines, practice management support, population health program implementation, and/or with other appropriate resources)
  • Implement basic quality improvement principles to provide technical assistance and support to improve practice performance while assessing trends in quality measures and identifying opportunities for quality improvement (e.g. AMH quality measures; value-based payment, access & availability, healthy opportunity and opioid strategies; EPSDT policies; and behavioral health integration)
  • Uses a systematic approach to identify practice needs and opportunities, perform data analysis, and develops actionable solutions to improve quality outcomes
  • Assist practices with analyzing and interpreting data to quickly identify problems, patterns, and high-risk activities
  • Facilitate discussions around different data visualization strategies, including differences in databases, and basic data sharing and management of resources
  • Support development, deployment and monitoring of State mandated performance improvement projects and other specific projects based on needs
  • Document provider outreach and work in a shared customer relationship management system, utilize to inform UHC internal staff connections and to collaborate on mutual providers and identified intersection points
  • Understand UHC and Optum provider-facing programs and processes to promote effective communication and collaboration
  • Participates, coordinates, and/or represents the Health Plan at community-based organization events, clinic days, health department meetings, and other outreach events 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:

  • Bachelor’s Degree in healthcare related field or business combined with 2+ years of equivalent work experience
  • 5+ years of clinical experience working with primary care practices, providing provider and liaison support
  • 3+ years of experience working with population health, patient centered medical homes (PCMH) and/or practice transformation efforts
  • 2+ years of quality improvement experience with responsibilities in the following areas rapid cycle change, data analysis and interpretation, systems analysis, graphical display of data/information, public speaking, group leadership and facilitation, and demonstrated problem solving and critical thinking skills
  • 2+ years of experience working in Medicaid and/or Medicare or the managed care industry
  • Experience in Health care and/or insurance industry experience, including regulatory and compliance
  • Intermediate experience in software applications skills that include, Microsoft Word, Excel, PowerPoint
  • Proven comfortable with creating presentations and working with data to formally present information to physicians, administrators, other providers and community partners, engaging different types of learners in various settings (e.g. practice offices, CIN/other partner offices, community settings
  • Ability to travel locally up to 25% of the time and up to 2 hours away from your residence, as needed
  • Reside locally to Charlotte, NC

Preferred Qualifications:

  • Graduate degree
  • CPHQ or CCM
  • Knowledge of one or more of: clinical standards of care, HEDIS, NCQA PCMH, and governing and regulatory agency requirements

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.