Clinical Practice Performance Consultant - Remote in MD

IntelliResume; Maryland; Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Benefits package

Incentive programs

Equity stock purchase and 401k

Job summary

UnitedHealth Group is seeking a Clinical Practice Performance Consultant in Columbia, MD to develop clinically oriented partnerships that enhance HEDIS quality scores and state-specific measures. The role involves managing provider quality measures and supporting NCQA accreditation compliance.

The position requires Maryland licensure (RN or LPN) with 5+ years clinical experience and 2+ years in quality improvement, working full-time during day shifts. Residency in Maryland is required.

Qualifications

• Current unrestricted LPN or RN licensure required in Maryland or ability to obtain licensure.
• 5+ years of clinical experience.
• 2+ years of quality improvement experience.
• Current RN License in Maryland required.

Responsibilities

• Develop clinically oriented partnerships to increase HEDIS quality scores.
• Manage provider practice quality measures and HEDIS medical record collection.
• Coordinate with the Quality Field Operations manager for provider performance improvement.
• Analyze and review quality outcomes at the provider level.
• Assist providers in meeting quality standards and state contractual requirements.
• Drive clinical relationships with physician practices, members, and pharmacies.
• Identify performance improvement opportunities through data analytics.
• Educate providers on clinical documentation, coding, and billing practices.
• Conduct onsite clinical evaluations through medical record audits.
• Support member care by identifying needs for health education and services.

Job description

About This Role

The Clinical Practice Performance Consultant is responsible for developing clinically oriented provider and community-based partnerships to enhance HEDIS quality scores and state-specific quality measures. This role involves managing provider practice quality measures and supporting NCQA accreditation compliance.

Highlights

• Pay: $72,800 - $130,000/year
• Location: Columbia, MD
• Schedule: Full Time, Day shift
• Residency: Must reside in Maryland

What You'll Do

• Develop clinically oriented partnerships to increase HEDIS quality scores.
• Manage provider practice quality measures and HEDIS medical record collection.
• Coordinate with the Quality Field Operations manager for provider performance improvement.
• Analyze and review quality outcomes at the provider level.
• Assist providers in meeting quality standards and state contractual requirements.
• Drive clinical relationships with physician practices, members, and pharmacies.
• Identify performance improvement opportunities through data analytics.
• Educate providers on clinical documentation, coding, and billing practices.
• Conduct onsite clinical evaluations through medical record audits.
• Support member care by identifying needs for health education and services.

Requirements

Education:

• Current unrestricted LPN or RN licensure required in the state of Maryland or ability to obtain licensure.

Experience:

• 5+ years clinical experience.
• 2+ years of quality improvement experience.

Licenses & Certifications:

• Current RN License in Maryland required.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution.

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on simplifying the health care experience and creating healthier communities while removing barriers to quality care.