Website United HealthCare
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 require travel to State sponsored meetings and to the Greensboro or Raleigh office.
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 within Greensboro, NC, you will have the flexibility to telecommute* as you take on some tough challenges.
- 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
- Bachelor’s Degree in healthcare related field or business combined with two years of equivalent work experience
- 5+ years clinical experience working with primary care practices, providing provider and liason support
- 3+ years 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
- 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
- This role requires travel to locally up to 75% of the time and may require travel up to 2 hours away from your residence on occasion
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
Company: United HealthCare
Vacancy Type: Full Time
Job Location: High Point, NC, US
Application Deadline: N/A