UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
The Clinical Transformation Consultant (CTC) is responsible for the ongoing clinical management of physician practices participating in UnitedHealthcare’s (UHC) Accountable Care Organizations (ACO), Value Based Programs, Patient Centered Medical Homes (PCMH), or Population Health Management programs.
The CTC will lead multi-disciplined practice transformation and practice performance improvement initiatives. The selected candidate will guide practices in achieving targeted goals that include improved quality, efficiency and utilization. The CTC is accountable for driving practice progress toward desired transformational change and performance improvement, while meeting savings goals set for the practice.
As the single point of clinical contact for a practice, the CTC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within UnitedHealthcare and at the practice.
If you are located in the state of OH, you will have the flexibility to telecommute* as you take on some tough challenges.
- Accountable for providing support for the Ohio Comprehensive Primary Care Medicaid Program at a practice and market level, including but not limited to, educating practices about quality and utilization opportunities, program components and updates, and Case Management liaison.
- Participate and support market-specific directives as mandated by the Ohio Department of Medicaid, including but not limited to, performance improvement projects, payer reporting and reconciliation, audits and participation in initiatives
- Support of clinical data exchange and interoperability of clinical information exchange via state health information exchanges and market-wide platforms
- 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 value/use of reporting tools, patient registries and delivery of reports via UHC’s Physician Portal
- Build and effectively maintain relationship with the practice leadership and key clinical influencers actively involved in practice transformation.
- Regularly facilitate efficient, effective practice improvement meetings with the practice 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
- Design practice transformation action plans and implement appropriate performance improvement initiatives designed to assist the practice in achieving contractually required transformation milestones
- Monitor and review the progress of the practice in milestone achievement and insure the practice is accountable for successful completion
- Use data to analyze key cost, utilization and quality data and interpret results to assess the performance of the practice
- Use data to analyze trends and work with stakeholders to agree on and implement proactive strategies to address issues, and measure impact using a PDSA rapid cycle improvement approach; including external practice data
- Assist practices in creating workflows to optimize care delivery, introduce best practices improvements, and evaluate outcomes using rapid cycle improvements PDSA methods to reach mutual goals
- Educate & Deploy technology tools to support Practice Transformation
- Integrate technology tools into practice workflows
- Build and effectively maintain relationships with team members in the UHC Clinical organization as well Medical Directors, local Network leads, Health Care Economic Analysts and Clinical Analysts in support of the program
- Consult and partners with internal UHC matrix partners and the practice to identify organizational and structural challenges hindering achievement of desired program outcomes.
- Collaborate with UnitedHealthcare teams including the practice Care Coordinators, quality management teams, hospital clinical teams, behavioral health teams to support integrated PCP driven care for our members with practices and hospitals
- Consult and guide the practice on developing innovative solutions, including bringing best practice experience and connecting practices with other high performing practices to spur innovation
- Assist and support department leaders in summarizing and disseminating experience-related learnings by way of team updates, written reports/articles, and/or presentations as called for by directors
- Participate in determination of annual HEDIS strategy for OH as wellas other clinical improvements
- Participate in the chart chase collection of records during HEDIS season
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.
- Bachelor's degree or equivalent relevant experience
- 4+ years of combined experience with improving clinical quality, establishing best practices, health care analytics, or driving clinical transformation initiatives with population health programs, Patient Center Medical Homes or in the managed care industry
- 2+ years of experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
- Experience working with and collaborating successfully with senior level leadership
- Demonstrated experience leading groups and solid presentation skills
- Solid Microsoft Office Skills with Word, Excel, Outlook and PowerPoint
- Solid Relationship building skills with internal and practice teams to drive goal alignment
- Access to high speed internet for home office set up
- Willingness to travel up to 25% for face to face meetings throughout the OH area
- Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area (markets may require valid driver’s license)
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Master's Degree
- Active, unrestricted RN license in the State of Residence
- Demonstrated experience implementing Clinical Practice Transformation initiatives designed to help provider or hospital groups achieve large-scale health transformation goals
- Experience preparing and presenting information to clinical and executive level leadership
- Physician practice experience
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
Job Keywords: RN, Registered Nurse, ACO, PCMH, Provider Relations, Clinical Practice Transformation, Implementation, Quality Improvement, Performance Improvement, Health Care Analytics, Managed Care, Healthcare, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Athens, Marietta, Point Pleasant, Lancaster, OH, Ohio