Remote Sr. Clinical Practice Consultant (CPC) – Washington State

UnitedHealthcare

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Requisition Number: 2188527
Job Category: Medical & Clinical Operations
Primary Location: Seatac, WA
(Remote considered)

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.

The Sr. Clinical Practice Consultant (CPC) is responsible for the ongoing clinical management of Community Based practices participating in UnitedHealthcare’s (UHC) Enhanced Care Management and Integrated Care Programs for Medicaid and DSNP. The CPC will lead multi-disciplined practice transformation and practice performance improvement initiatives. The selected candidate will guide practices in achieving targeted goals that include oversight of care management programs and achieving Integrated Care practice transformation goals. The CPC is accountable for driving practice progress toward desired transformational change and performance improvement, while meeting savings goals set for the practice.

The Six Enhanced Care Management Services are:

  • Care Coordination – Cross system care coordination activities to assist participant’s in accessing and navigating needed services
  • Care Transitions – Proper and Timely follow-up care to prevent avoidable readmission after discharge from an ER and inpatient facilities
  • Referral Management – Identification of available community-based resources and actively managing referrals, assistance to the beneficiary in advocating for access to care and engagement with community and social supports related to goal achievement documented in the Health Action Plan (HAP) through the use of information technology services.
  • Health Promotion – Begins with the commencement of the Health Action Plan (HAP), demonstrating use of self-management, recovery and resiliency principles using person-identified supports. Addressing gaps in care
  • Individual Support – Support the beneficiary to access and navigate the healthcare and social service delivery system as well as support health action planning
  • Family/Caregiver Support – Support to the beneficiary’s family and/or caregiver to access and navigate the healthcare and social services delivery systems as well as support health action planning

Integrated Care goals are:

  • Meeting a provider practice where they are on their integrated practice journey
  • Assessing the practice
  • Facilitating feedback and providing technical assistance joint operating meetings with practices to further practice transformation

As the single point of clinical contact for a practice, the CPC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within UnitedHealthcare and the Community Based Provider.

If you are located within commutable driving distance from the WA area, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Accountable for successful deployment of UHC’s Clinical Support program at the practice level, including but not limited to, introducing, and educating practices on the interpretation of data, closing care gaps, and ensuring social determinants of health are addressed
  • Build and effectively maintain relationship with the Community Based organizational leadership and key clinical influencers actively involved in practice transformation
  • Regularly facilitate efficient, effective practice improvement meetings with the Community Based Provider to monitor, present, and discuss progress on the transformation action plan and achievement in milestones
  • Develop strategies; based on performance analysis, for improvement that includes specific outcomes and metrics to monitor progress to a goal and make recommendations for improvement
  • Where outcomes are below goal, the CPC will identify outlier member files for focused action plans and/or clinical case round review or reduce barriers to practice transformation concerns
  • Audit of Enhanced Care Management assessments and member care plans to ensure compliance with regulatory requirements and policies and procedures
  • Use data to analyze trends and work with stakeholders to agree on and implement proactive strategies to address issues, and measure impact using a Plan-Do-Study-Act (PDSA) rapid cycle improvement approach; including external practice data
  • Educate, train, and deploy technology tools to support Practice Transformation
  • Consult and partner with internal UHC matrix partners and the practice to identify organizational and structural challenges hindering achievement of desired program outcomes
  • Assist and support department leaders in summarizing and disseminating experience – related learning’s by way of team updates, written reports / articles, and / or presentations as called for by directors
  • Ensure all required member documents as indicated in the Community and State UnitedHealthcare contract for Health Home and future Enhanced Care Management programs

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 or equivalent relevant experience
  • Active, unrestricted License as Social Worker or Mental Health Professional (LMHC, LCSW, LMSW, LMFT, LMHP) in the State of Washington or active, unrestricted license as a nurse in the State of Washington
  • 5+ years of combined experience with improving health quality outcomes
  • Demonstrated knowledge of community-based resources in Washington
  • Experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
  • Demonstrated experience leading groups and strong presentation skills
  • Demonstrated solid Microsoft Office Skills with Word, Excel, Outlook, and PowerPoint
  • Proven solid relationship building skills with internal and practice teams to drive goal alignment
  • Reside within commutable driving distance from SeaTac, WA office
  • Willingness to travel up to 10% for face-to-face meetings within Seattle, WA and surrounding areas
  • Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area (valid driver’s license)

Preferred Qualifications:

  • Master’s Degree
  • Certified Case Manager (CCM)
  • Demonstrated experience implementing Clinical Practice Transformation initiatives designed to help provider or hospital groups achieve large-scale health transformation goals
  • Community Safety Net Provider Systems of Care experience

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

Washington Residents Only: The salary range for Washington residents is $85,000 to $167,300. 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.