Provider Enablement Consultant

RXinsider LTD.; Phoenix, Northern (AZ, KY); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Medical Plan options

Dental, Vision, Life & AD&D

401(k) Savings Plan

Education Reimbursement

Paid Time Off

Paid Holidays

Employee Discounts

Employee Assistance Program

Job summary

UnitedHealth Group is seeking a Provider Enablement Consultant to manage ongoing clinical oversight of value-based behavioral health programs. You will develop relationships with providers, drive quality improvement, monitor performance, and support care coordination across departments.

The role requires strong clinical and analytic skills, collaboration with senior leaders, and ability to work remotely from anywhere in the US with a dedicated home office.

Qualifications

• Active and unrestricted Master’s level clinician in Psychology, Social Work, Counseling or Marriage/Family Counseling, or Licensed Psychologist (PhD/PsyD) or RN with state licensure.
• 3+ years post-licensure direct behavioral health clinical experience.
• 1+ years in a managed care setting.
• 1+ years of analysis, reporting, and data analytics within healthcare, Medicaid, or health & human services.

Responsibilities

• Build and maintain relationships with provider leadership and clinical staff.
• Regularly facilitate oversight meetings with providers to monitor performance.
• Monitor provider performance on program metrics and adherence to contract requirements.
• Identify performance improvement opportunities via operational, clinical, and utilization data.

Skills

Clinical leadership

Data analytics

Microsoft Excel

Communication

Education

Master’s degree-level clinician in psychology, social work, counseling or related field

Licensed Ph.D./Psy.D. psychologist or RN (licensure in state of residence)

Tools

Excel

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Provider Enablement Consultant (PEC) is responsible for the ongoing clinical management and quality oversight of Optum Behavioral Health's value-based programs. The PEC will be responsible for developing relationships with participating behavioral health providers and facilities, and driving a quality improvement process to improve quality, improve clinical outcomes, increase efficiency and reduce overall benefit expense. The PEC will monitor provider performance and compliance with contractual obligations, provide tools to assist with performance and compliance, and is accountable for driving provider performance improvement. As the single point of clinical contact for a provider, the PEC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within Optum and the participating provider.

The PEC must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume facilities/groups and/or providers. This PEC will work closely with Care Advocacy Operations, Affordability, Network Management teams and other relevant departments to affect desired outcomes with the participating provider as it relates to treatment for our membership.

Location

You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. A dedicated work from home space is required.

Schedule

Monday-Friday, 8am-5pm in time zone of residence. Flexibility may be required to work outside of standard business hours, depending on business need.

Primary Responsibilities

• Build and effectively maintain relationships with provider leadership and key clinical staff
• Regularly facilitate oversight meetings with providers to monitor, present, and discuss performance
• Monitor provider performance on program metrics, quality outcomes and adherence to contract requirements
• Identify performance improvement opportunities through analysis of operational data, clinical outcome data and utilization/claims data
• Communicate with providers to initiate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with contractual obligations
• Initiate and monitor Quality Improvement Plans to drive performance
• Conduct provider program audits and provide feedback and results
• Support high performing providers such that performance remains at a high level
• Provide clinical and care coordination support
• Deliver education and training
• Interface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement

What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Active and unrestricted Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D/Psy.D. level Psychologist, or Bachelor's level RN (licensure must be in state of residence)
• 3+ years post-licensure direct behavioral health clinical experience
• 1+ years of experience in a managed care setting
• 1+ years of experience performing analysis, reporting, and data analytics within healthcare, Medicaid, and/or health & human services environment
• Intermediate level of proficiency with Microsoft Office (Excel required)

Preferred Qualifications

• Working knowledge of Public Sector benefit plans
• Experience identifying performance improvement opportunities and influencing quality metrics
• 3+ years of Managed Care experience
• Ability to balance contractual and clinical considerations
• Strong relationship building and influencing skills
• Strong written and verbal communication skills
• Excellent time management and prioritization skills
• All Telecommuters 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 $72,800 to $130,000 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.