Quality consultant

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 Provider Quality Engagement Consultant (PQEC) position is responsible for strategically developing provider and community-based partnerships in order to increase quality scores based on priorities.

This role will be responsible for ongoing management of provider practice and community education on state specific quality measures.

The Provider Quality Engagement Consultant will work closely with the quality director to coordinate an interdisciplinary approach to increased provider performance.

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.

This 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.

If you are located in Hazard, Kentucky, or within commutable driving distance, you will have the flexibility to work remotely* as you take on some tough challenges.

This is a field based position where you will travel locally to physician offices up to 75% of the time.

Primary Responsibilities :

• Developing provider partnerships to increase quality scores based on state specific quality measures
• Provider education including analysis and review of outcomes, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, and pay for performance initiatives
• Uses critical thinking and analyzes provider reports to identify opportunities for preventative care services for members
• Serves as the primary point of contact for provider incentive programs
• Escalates provider concerns
• Participate in providers events, town hall meetings, or collaborate with other external partners in the community or local or state government
• Key member of the quality team by supporting : Quality Performance Improvement Projects (PIPs); Health Plan or Department initiatives;

Provider education and data collection from providers

• Collaborates with Internal & External partners
• Maintains Current and Accurate Documentation
• 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 HEDIS / State Measure rates

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

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 :

• 2 years of relevant work experience in provider relations, community outreach, consulting, health care, or quality improvement
• Intermediate proficiency with MS Project, PowerPoint, and SharePoint
• Intermediate proficiency with Excel to include pivot tables, v-lookup and other data manipulation skills
• Proven ability to influence and work with a wide range of internal and external stakeholders / resources to move projects and programs forward and overcome any challenges
• Proven ability to travel up to 75% within the Hazard, KY and surrounding areas
• Proven excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
• Proven solid problem solving and analytical and skills
• Proven excellent communication skills both written and verbal
• Reliable transportation to visit assigned providers
• Reside within the Commonwealth of Kentucky

Preferred Qualifications :

• Certified Professional Coder (CPC)
• Certified Professional in Healthcare Quality Certification (CPHQ), IHI certificate or Lean background
• Experience working with Medicaid population
• Experience working with a Managed Care Organization
• Experience with HEDIS and NCQA
• Reside in the Hazard, Kentucky area

Skills and Abilities :

• Self-directed, independent, and proactive with a track record of initiation
• Possess solid listening skills, demonstrated by high level of responsiveness and follow through
• Comfortable working through ambiguity and is adaptable to change
• Understanding of primary care best practices, clinical processes, and process improvement skills
• Demonstrated ability to summarize key business learning, and translate into tactical plans and report to executive level management
• Demonstrated ability to influence non-direct reports, both internally and externally
• Demonstrated ability to make recommendations and implement quality improvement interventions based on results of projects.

Converts data into useable information and measures the impact of improvement initiatives

Demonstrated commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques;

Open to innovation, creative ideas, will completely re-engineer work processes when needed. Promotes quality focus among others

• Uses Critical Thinking
• Leverages Our United Culture values of Integrity, Compassion, Relationships, Innovation and Performance internally and in customer commitments
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere : UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Last updated : 2024-07-12