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Senior Clinical Practice Performance Consultant Auditor - CA

UnitedHealth Group

Sacramento, CA
Job Code:
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Job Details

Senior Clinical Practice Performance Consultant Auditor - CA(Job Number:730618)

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 and help people live healthier lives while doing your life's best work.(sm)


Position responsible for strategically developing clinically oriented provider and community based partnerships in order to increase quality scores based on state specific quality measures and to complete DHCS facility site, medical record and physical accessibility reviews. Position responsible for ongoing management of provider practice and community education on state specific quality measures. The Senior Registered Nurse CPC / FSR will work closely with the quality director and other internal and external stakeholders to coordinate an interdisciplinary approach to increased provider performance and compliance. Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level, monitoring, measuring and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives.


The Senior Registered Nurse CPC / FSR will focus on tasks that occur in accordance with State, CMS or other requirements as applicable. Position responsible for direction and guidance on provider-focused, clinical quality improvement and management programs. The role serves as the Subject Matter Expert for the Quality Nurses and provides support in the planning, implementation, and evaluation of Quality audits in collaboration with the Quality Team. The Senior Clinical Practice Performance Consultant Auditor will serve as the liaison between state regulators and health plan partners; and is responsible for leading Quality functions including data submission to Regulators, participation in Collaborative meetings, Corrective action planning, annual Inter-Rater Reliability reviews, and other duties as warranted by holding DHCS Master Trainer and Certified Site Reviewer certifications.  
The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. Position will be responsible for coordinating visits and any administrative functions associated with the site visits. 


This is a Telecommute role based in California and requires travel to physician offices in San Diego and Sacramento up to 75% of their time.


Primary Responsibilities:

  • Complete Facility Site, Medical Record and Physical Accessibility Reviews
  • Education and Engagement of Practice Level Leadership
  • Targeted Quality Improvement
  • Gaps in Care Closure
  • Relationship Management, Internal and External
  • Community Engagement and Interaction
  • Provider and Practice Education, Quality Oriented Health Topics

Job Quality Management
Primary Location US-CA-Sacramento
Other Location US-CA-San Diego
Organization C&S Quality Management
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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