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Clinical Quality Consultant - Tacoma / Seattle, WA - Telecommute

UnitedHealth Group


Location:
Seattle, WA
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1782065
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Job Details


Clinical Quality Consultant - Tacoma / Seattle, WA - Telecommute(Job Number:728738)
Description

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)

 

Will travel in King County in Seattle Washington and Pierce County in Tacoma up to 75% of the time.

 

Primary Responsibilities:

  • Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
  • Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS / State Specific quality measures for provider and staff education during field visits

    • Materials additionally include information from local, state and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
  • Works closely with the Health Plan Chief Medical Director(s) and other appropriate stakeholders implementing  and monitoring the quality performance of  value based provider contracts and reporting of findings at joint operations meetings
  • Serves as subject matter expert (SME) for assigned HEDIS / State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve Will travel in King County in Seattle Washington and Pierce County in Tacoma up to 75% of the time.h Plan at community based organization events, clinic days, health department meetings and other outreach events focused on quality improvement, member health education and disparity programs as assigned
  • Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
  • Reports individual member quality of care concerns or trends of concern to the Health Plan Quality Director
  • Coordinates and performs 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
  • Investigates 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
  • Based on medical record audit findings, provides follow-up education, practitioner intervention and measurement as needed to drive quality improvement
  • Educates providers and office staff on proper clinical documentation, coding and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria, to drive quality improvement
  • Supports continuum of member care by identifying members in need of health education and/or services (case management, etc.) and refers members to the appropriate internal departments per policy
  • Documents and refers 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
  • Works with providers on standards of care, and advises providers on established clinical practice guidelines and appropriate documentation and billing consistent with state specific measures and technical specifications
  • If required, supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection or for other focus studies as directed by the Plan Quality Director
  • Supports quality improvement program studies with work that ranges from accessing and analyzing provider records, maintaining databases and researching to identify members' encounter history
  • Participates in or coordinates with other department projects as needed
  • Needs to works independently and within an integrated team in a highly matrixed environment
  • May do additional duties as assigned

Job Clinical Quality Management
Primary Location US-WA-Seattle
Other Location US-WA-Tacoma
Organization C&S Quality Management
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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