Clinical Practice Consultant - Remote in Southwest Idaho and surrounding areas
Company: UnitedHealthcare
Location: Boise
Posted on: May 8, 2025
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Job Description:
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 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.
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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.
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If you reside in Idaho, you will have the flexibility to work
remotely* as you take on this challenging and rewarding work. -
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Primary Responsibilities:
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
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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 -
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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
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy -
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-The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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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. - -
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UnitedHealth Group is 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. -
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment. -
Keywords: UnitedHealthcare, Nampa , Clinical Practice Consultant - Remote in Southwest Idaho and surrounding areas, Healthcare , Boise, Idaho
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