HEDIS & Quality Improvement Clinical Practice Consultant

UnitedHealthcare; Columbia (MD); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking a Clin Practice Performance Consultant to drive HEDIS and state quality measures through provider engagement and education in Maryland. You will analyze data, educate clinics, and coordinate with internal teams to improve care quality while controlling costs.

The role requires MD-licensed clinicians with 5+ years of clinical experience and at least 2 years in quality improvement.

Qualifications

• Current unrestricted LPN or RN licensure required in Maryland or ability to obtain licensure for Maryland
• 5+ years clinical experience
• 2+ years of quality improvement experience
• Proficiency in Word, Excel, PowerPoint
• Travel to physician offices locally up to 50% of time

Responsibilities

• Serves as SME for assigned HEDIS/State Measures and quality topics; leads efforts with clinical team to develop educational materials for practitioner offices; liaises with vendors supporting HEDIS/State Measures
• Represents Health Plan at community events, clinic days, and health department meetings focused on quality improvement and member health education
• Identify population-based barriers to care and work with QMP team to close gaps in care
• Report quality concerns to Quality Manager and support providers with data-driven improvement plans
• Perform onsite clinical evaluations through chart audits to ensure proper coding and billing practices
• Educate providers on documentation, coding, billing practices, and state metric specifications to drive quality improvement
• Identify members needing education/services and refer to internal departments; document and escalate provider issues to relevant teams

Skills

RN licensure

Quality improvement

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Travel up to 50%

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

UnitedHealthcare is seeking a Clin Practice Performance Consultant to drive HEDIS and state quality measures through provider engagement and education in Maryland. You will analyze data, educate clinics, and coordinate with internal teams to improve care quality while controlling costs.

The role requires MD-licensed clinicians with 5+ years of clinical experience and at least 2 years in quality improvement.