Remote Behavioral Health Clinical Practice Specialist, Plymouth, MN

Optum

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Requisition Number: 2185799
Job Category: Behavioral
Primary Location: Plymouth, MN
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Practice Management Outpatient Clinical Practice Specialist must demonstrate solid clinical and analytic skills, solid oral and written communication skills and must be comfortable working closely with senior leaders at high volume providers and/or groups/facilities.   The Practice Specialist will be responsible for the development of relationships with, outpatient behavioral health providers as well as groups and facilities.  The Practice Specialist will monitor their clinical effectiveness and efficiency, as well as compliance with contractual obligations.   This Specialist will work closely with Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity teams to affect desired outcomes with facilities/programs/providers as it relates to treatment for our membership.

The Specialist will partner with providers/groups/facilities  in the following manner:

Those providers and or groups/facilities that operate outside of typical practice or billing patterns will be subject to a specific set of interventions.  The Practice Specialist’s role with these providers/groups/facilities will be to coordinate a strategic effort that includes Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity with the goal of designing and delivering interventions aimed at improving clinical performance and outcomes.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Interface with senior leaders (e.g., CEO) at high volume providers or facilities/groups as indicated
  • Communicate with facilities/groups/providers to initiate appropriate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with clinical processes and contractual obligations
  • Support those high performing providers, groups, and facilities such that performance remains at a high level
  • Identify outliers through analysis of clinical outcomes data, utilization/claims data, complaints, and compliance with care advocacy protocols
  • Measure improvement of program/provider performance over time
  • Monitor and report effectiveness of interventions
  • Modify interventions as appropriate
  • Initiate and monitor Performance Improvement Plans (PIPs) as appropriate to affect performance as the result of audit activity
  • Interface with other Optum departments including Clinical Operations, Provider Relations and Contracting, Legal, and Program and Network Integrity as appropriate

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:

  • Licensed Master’s degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D. level Psychologist, or Registered Nurse
  • Licenses must be independent, active, and unrestricted
  • 3+ years of Managed Care and/or Utilization Review experience in a Managed Care setting
  • Solid knowledge of CPT/HCPCS codes
  • Solid analytical skills with knowledge of or willingness to learn analytics software such as Microsoft Excel
  • Solid computer skills at the intermediate level, proficiency with MS Office
  • Proven solid communication skills, written and verbal
  • Proven excellent time management and prioritization skills
  • Proven ability to balance contractual and clinical considerations
  • Proven ability to establish and maintain strategic relationships with leadership teams

Preferred Qualification:

  • MI license and residence

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents OnlyThe salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.  

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