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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 health plan 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 Kentucky, 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 within the Commonwealth of Kentucky area, up to 75% of the time. Primary
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
BA/BS degree in Business, Healthcare Administration, Public Health, Communications, Nursing or related field and/or equivalent education and experience 3+ 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 excellent time management, organizational, and prioritization skills and ability to balance multiple priorities Demonstrated solid problem solving and analytical and skills Demonstrated 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 Demonstrated excellent communication skills both written and verbal Ability to travel up to 75% within the Commonwealth of Kentucky area Reliable transportation to visit assigned providers Reside within the Commonwealth of Kentucky area
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 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 Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment.
We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.