Clinical Practice Consultant - Oahu​/Kauai

At United Healthcare, 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.

If you are located on Oahu or Kauai, HI you will have the flexibility to work remotely
* as you take on some tough challenges. (Please note that this is a work from home opportunity, but you still need to live in or near the posted area). Travel will be required on Hawaii Island and neighbor islands about 75% of the time.

• Educates providers and office staff on proper clinical documentation, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
• 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)
• 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
• Participates, coordinates, and/or represents the Health 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
• 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
• Supports continuum of member care by referring members to the appropriate internal departments per policy as needs arise
• Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation consistent with state specific measures and technical specifications
• Other duties as assigned

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.

• 3+ years of health care related experience
• 2+ years of experience in managed care or equivalent healthcare experience, including regular interaction with providers regarding clinical quality improvement processes
• Proficiency using a PC in a Windows environment, including Microsoft Outlook, Word, Excel, and Power Point
• Ability to Travel to physician offices locally up to 75% of the time in Hawaii
• Access to reliable transportation, and proof of automobile insurance

• Current unrestricted RN or MSW licensure in the State of Hawaii
• Experience working in Medicaid and/or Medicare
• Knowledge of one or more of: clinical standards of care, preventive health…