Senior Clinical Practice Performance Consultant

UnitedHealth Group; La Crosse (WI); Hybride; USD 92 000 - 164 000; Plein temps

Résumé du poste

UnitedHealth Group seeks a Senior Clinical Practice Performance Consultant to provide enterprise-level clinical guidance across strategy, quality, and regulatory alignment. You will help design scalable, audit-ready models and governance structures for diverse OSHS programs, collaborating with Legal, Compliance, and Operations.

The role supports telehealth, workforce design, and policy development while ensuring readiness, performance improvement, and risk mitigation across multiple states.

Qualifications

• Bachelor’s degree in nursing, healthcare, public health or healthcare administration.
• Active, unrestricted Registered Nurse license, MSN, BSN, RN, NP.
• 8+ years of progressive clinical, healthcare operations, quality, regulatory, program-development, or consulting experience.
• Experience interpreting federal and state healthcare requirements and accreditation standards.
• Experience developing or reviewing clinical policies, SOPs, workflows and quality-management documents.
• Experience evaluating scope of practice, licensure, delegation, supervision and credentialing.
• Ability to synthesize complex clinical, regulatory and operational information into practical recommendations.
• Ability to communicate with senior leaders, clinical SMEs and cross-functional teams.

Responsabilités

• Provide senior-level clinical consultation for OSHS programs and enterprise initiatives.
• Evaluate clinical models for safety, quality, regulatory alignment and operational feasibility.
• Develop and maintain enterprise clinical governance architecture and standards.
• Translate complex requirements into practical standards for leadership and frontline teams.
• Identify enterprise clinical gaps and opportunities for standardization across programs.
• Apply High Reliability Organization principles to risk identification and improvement.
• Lead clinical solutioning for RFIs/RFPs, contract modifications and new-business development.
• Support governance, documentation, and audit readiness across regulated activities.

Connaissances

Clinical consultation

Regulatory compliance

Quality improvement

Policy development

Formation

Bachelor’s degree in nursing, healthcare, public health or healthcare administration

Outils

Microsoft Word

Excel

PowerPoint

Teams

SharePoint

Description du poste

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Senior Clinical Practice Performance Consultant (2394337)

Senior Clinical Practice Performance Consultant - 2394337

Explore opportunities with Logistics Health Incorporated

(LHI), part of the Optum family of business. We’re dedicated to simplifying the logistics of complex workforce health programs with cost-effective solutions and a seamless distribution process. With offices in La Crosse, Wis., a satellite office in Chicago and remote employees throughout the country, we have a variety of rewarding career opportunities for you. Elevate your career as you help us create a healthier tomorrow for everyone and discover the meaning behind Caring. Connecting. Growing together.

Caring. Connecting. Growing together.

The Senior Clinical Practice Performance Consultant is a senior clinical subject matter expert within Optum Serve Health Services’ Clinical Quality & Patient Safety function. The position provides enterprise-level consultation across clinical strategy, quality, regulatory alignment, policy and document governance, clinical business development, workforce and care-delivery model design, operational readiness, technology enablement, and continuous improvement. The consultant translates federal and state requirements, contract obligations, accreditation standards, evidence-based practices, and clinical operations into practical, scalable, and audit-ready solutions. The role develops and maintains multi-state clinical regulatory infrastructure; evaluates telehealth, telepresenter, mobile, home-based, occupational-health, readiness, and evaluative examination models; and supports collaborative-practice and supervisory governance for regulated clinical professionals. The role partners across Business Development, Capture and Proposal teams, Care Delivery, Program Operations, Quality, Compliance, Legal, Credentialing, Medical Directors, Clinical Enablement, Product, Technology, Privacy, Finance, Human Capital, Environmental and Occupational Health, and other enterprise functions. The Senior Clinical Practice Performance Consultant supports established programs and new initiatives by defining clinical service models, evaluating scope of practice and licensure requirements, developing and maintaining clinical policies and internal standards, identifying clinical and operational risk, supporting quality and surveillance activities, reviewing training and competency requirements, and advising on implementation and performance improvement.

Role Scope and Level of Influence:

• Serves as a senior enterprise individual contributor and clinical advisor across multiple programs, functions, and strategic initiatives
• Leads complex clinical analyses and cross-functional workstreams without relying on direct supervisory authority
• Influences enterprise and program decisions through evidence, clinical judgment, structured analysis, and stakeholder engagement
• Provides recommendations and escalates material risks while partnering with the accountable functions responsible for final legal, compliance, credentialing, medical, policy, and operational determinations
• May mentor peers, guide project teams, facilitate governance activities, and provide functional leadership for assigned initiatives

You’llenjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Clinical Strategy and Performance
  • Provide senior-level clinical consultation for OSHS programs, enterprise initiatives, new service lines, and strategic growth opportunities
  • Evaluate clinical models for safety, quality, regulatory alignment, contractual compliance, operational feasibility, scalability, and workforce readiness
  • Develop and maintain enterprise clinical governance architecture, including governance charters, internal clinical standards, regulatory crosswalks, gap-assessment frameworks, evidence and artifact requirements, decision pathways, accountability structures, and implementation guidance
  • Translate complex clinical and regulatory requirements into practical standards for program leadership, operations, and frontline implementation
  • Identify enterprise-level clinical gaps, inconsistencies, and opportunities for standardization across programs
  • Apply High Reliability Organization principles to clinical decision-making, risk identification, and continuous improvement
• Clinical Business Development and Solutioning
  • Serve as the clinical SME for RFIs, RFPs, contract modifications, capture activities, solutioning sessions, and new-business development
  • Interpret solicitation and contract requirements to define clinical services, care modalities, workflows, staffing models, professional qualifications, supervision structures, and quality requirements
  • Conduct clinical gap and capability analyses comparing customer requirements with organizational resources, policies, infrastructure, technology, and workforce capacity
  • Develop or review clinical narratives, staffing assumptions, qualification matrices, scope-of-service descriptions, transition plans, readiness requirements, and implementation strategies
  • Contribute to Quality Control Plans, Quality Management Plans, clinical metrics, audit methodologies, corrective-action pathways, and performance-monitoring structures
  • Identify clinical assumptions, dependencies, risks, cost drivers, and implementation requirements during proposal development and post-award transition
• Scope of Practice, Licensure, Delegation, and Supervision
  • Research and assess federal and state requirements affecting licensed professionals, unlicensed assistive personnel, telehealth practice, mobile care, occupational health, home-based services, and other care-delivery models
  • Develop and maintain scope-of-practice standards and reference tools for physicians, advanced practice clinicians, nurses, medical assistants, emergency medical personnel, technicians, and other clinical or ancillary roles
  • Evaluate permitted functions, prohibited functions, supervision requirements, delegation rules, documentation expectations, competency requirements, and jurisdiction-specific limitations
  • Assess proposed staffing and workforce models against practice acts, board rules, federal authorities, contract requirements, credentialing standards, and internal policies
  • Advise on compact participation, federal exceptions, telehealth licensure, OCONUS considerations, and program-specific authorization
  • Develop, evaluate, and maintain governance frameworks for collaborative-practice, supervisory, delegation, and clinical-oversight relationships involving physicians, advanced practice clinicians, nurses, and other regulated professionals
  • Assess state-specific agreement, filing, notification, alternate-covering practitioner, physician-availability, quality-review, and documentation requirements and support implementation with accountable enterprise partners
  • Design and maintain enterprise regulatory matrices, quick-reference guides, decision tools, and state-specific implementation resources with defined source standards, review cadence, change tracking, and validation pathways
  • Identify and escalated unresolved scope, licensure, credentialing, supervision, or delegation risks to the appropriate accountable function
• Clinical Policy and Document Governance
  • Lead or support the research, drafting, review, revision, standardization, and maintenance of clinical policies, procedures, standards, SOPs, work instructions, protocols, job descriptions, clinical forms, and implementation tools
  • Ensure clinical documents reflect evidence-based practice, professional standards, applicable requirements, accreditation expectations, contract obligations, and operational workflows
  • Coordinate interdisciplinary review with clinical SMEs, Operations, Legal, Compliance, Quality, Credentialing, Medical Directors, Enablement, and affected stakeholders
  • Support document intake, assignment, version control, approval, publication, change control, archival, and periodic review
  • Maintain traceability between source requirements, clinical decisions, approved standards, training, workflows, and audit tools
  • Identify conflicting, duplicative, outdated, or unsupported clinical documents and recommend consolidation or remediation
• Regulatory, Accreditation, and Evidence Surveillance
  • Monitor and analyze changes in federal and state healthcare requirements, professional-practice standards, public-health guidance, and accreditation expectations that may affect OSHS operations
  • Conduct targeted regulatory and clinical research using authoritative primary sources
  • Develop impact assessments that distinguish explicit requirements, interpretation, operational implications, risks, and recommended actions
  • Evaluate changes affecting licensure, telehealth, occupational health, medication administration, laboratory services, infection prevention, medical equipment, clinical documentation, delegation, supervision, and workforce qualifications
  • Translate requirements into recommended changes to policy, training, workflow, quality controls, and operational processes
  • Maintain documented evidence, source citations, effective dates, jurisdictional limitations, and unresolved questions
  • Monitor pending legislation, proposed regulations, board actions, compact developments, and emerging professional standards; assess anticipated impact and recommend proactive policy, staffing, contracting, training, or implementation changes
• Clinical Risk, Quality, and Patient Safety
  • Identify clinical, regulatory, operational, workforce, and patient-safety risks associated with current and proposed services
  • Conduct or support risk assessments, gap analyses, root cause analyses, incident reviews, failure-mode evaluations, and corrective-action planning
  • Evaluate the clinical implications of audit findings, documentation trends, complaints, adverse events, near misses, performance metrics, and operational variation
  • Recommend risk controls, escalation pathways, monitoring methods, competency requirements, and corrective or preventive actions
  • Support development of audit criteria, surveillance tools, readiness assessments, clinical dashboards, and quality indicators
  • Ensure identified risks are clearly documented, assigned to an accountable owner, escalated appropriately, and monitored to resolution
• Clinical Workforce and Care-Delivery Model Design
  • Design or evaluate workforce models for fixed-site, mobile, virtual, embedded, event-based, surge, occupational-health, and home-based services
  • Define appropriate clinical roles, qualifications, staffing ratios, supervision structures, escalation coverage, competency requirements, and operational boundaries
  • Assess the suitability of licensed and unlicensed personnel for proposed clinical functions
  • Evaluate workforce models for patient safety, legal scope, operational feasibility, workforce availability, cost implications, and scalability
  • Support development of job descriptions, role profiles, competency frameworks, interview criteria, resume-review standards, and onboarding requirements
  • Advise on innovative staffing approaches while ensuring alignment with scope, licensure, policy, and contract requirements
  • Evaluate telehealth, telepresenter, remote-supervision, and hybrid service models, including clinical appropriateness, physical-examination limitations, personnel qualifications, documentation standards, technology dependencies, escalation pathways, and requirements for in-person care
  • Differentiate clinical requirements according to program purpose and legal structure, including treatment, occupational health, medical surveillance, disability evaluation, readiness assessment, triage, advisory, and administrative examination models
  • Evaluate task-level authority and competency requirements for ancillary procedures and diagnostic services, including phlebotomy, electrocardiography, spirometry and pulmonary function testing, ankle-brachial index testing, medication-related activities, specimen handling, and telepresenter-assisted examination functions
• Training, Onboarding, and Competency Oversight
  • Define clinical learning requirements for new programs, clinical roles, policies, workflows, and regulatory changes
  • Clinically review onboarding, sustainment, remediation, and annual competency content developed by Enablement or other training owners
  • Ensure training aligns with approved policy, scope of practice, licensure, delegation, supervision, contractual obligations, and operational expectations.
  • Develop or contribute specialized clinical subject-matter content when required.
  • Establish clinical competency criteria, validation methods, assessor qualifications, reassessment requirements, and documentation expectations
  • Evaluate training effectiveness and recommend updates based on audit findings, operational feedback, incidents, regulatory changes, and performance trends.
• Occupational and Environmental Health Consultation
  • Provide clinical consultation for occupational health, medical surveillance, workforce health, infection prevention, exposure response, vaccination, fitness-for-duty, and employee-safety programs
  • Evaluate workplace clinical protocols, employee-health workflows, medical-screening requirements, exposure risks, and field-safety considerations
  • Establish or evaluate clinical standards and operational controls for medications, vaccines, laboratory and point-of-care testing, medical equipment, supplies, specimen handling, infection prevention, temperature control, emergency response resources, and regulated medical waste, including personnel authorization, competency, maintenance, quality control, documentation, and escalation requirements
  • Assess clinical and workforce risks associated with mobile, home-based, remote, and field operations, including home-entry protocols, lone-worker safety, environmental hazards, emergency communication, transportation and vehicle liability, equipment and supply security, infection control, accompaniment criteria, and field-readiness requirements.
  • Collaborate with Environmental and Occupational Health, Operations, Legal, Compliance, and program leadership on risk mitigation and implementation

Technology and Clinical Workflow Consultation

• Define clinical, documentation, safety, privacy, quality, and workflow requirements for electronic health records, clinical platforms, digital tools, telehealth solutions, and emerging technologies
• Translate clinical operations into functional business and system requirements
• Lead or support development of clinical and information-governance requirements for electronic health records and related platforms, including longitudinal record management, active and inactive diagnoses, problem-list reconciliation, continuity of care, role-based access, patient versus employer visibility, occupational-health record separation, PHI controls, audit trails, clinical decision support, and contract-specific reporting.
• Participate in system selection, requirements development, workflow mapping, user-acceptance planning, implementation, and optimization
• Evaluate whether proposed technology supports safe care, regulatory compliance, contractual reporting, clinical governance, and auditability

You’llbe 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 asprovidedevelopment for other roles you may be interested in.

Required Qualifications:

• Bachelor’s degree in nursing, healthcare, public health or healthcare administration
• Active, unrestricted Registered Nurse license, MSN, BSN, RN, NP
• 8+ years of progressive clinical, healthcare operations, quality, regulatory, program-development, or consulting experience
• Significant experience interpreting and applying federal and state healthcare requirements, professional-practice standards, clinical policy, or accreditation requirements.
• Experience developing, reviewing, or implementing clinical policies, SOPs, workflows, standards, or quality-management documents
• Experience evaluating clinical scope of practice, licensure, delegation, supervision, credentialing, or professional qualifications
• Experience leading complex, cross-functional clinical initiatives in a matrixed organization
• Demonstrated ability to synthesize complex clinical, regulatory, contractual, and operational information into practical recommendations
• Demonstrated experience communicating with senior leaders, clinical SMEs, operational teams, and nonclinical stakeholders
• Advanced proficiency with Microsoft Word, Excel, PowerPoint, Teams, and SharePoint
• Ability to manage multiple high-priority assignments with competing deadlines and incomplete or evolving information
• United States citizenship is required for this position
• Ability to obtain and maintain a suitability or determination of eligibility for a Confidential/Secret or Top Secret security clearance
• 25 % travel

Preferred Qualifications:

• Master of Science in Nursing, healthcare administration, public health, business administration, or a related advanced degree
• Executive MBA or other advanced business, strategy, or healthcare leadership education
• 10+ years of progressive clinical and healthcare leadership experience
• Experience in federal healthcare, government contracting, military health, Veterans’ health, public health, occupational health, or distributed national care delivery.
• Experience with RFI/RFP responses, capture activities, proposal development, clinical solutioning, Quality Control Plans, or post-award transition
• Experience with clinical governance, Joint Commission accreditation, High Reliability Organization implementation, quality improvement, or patient-safety systems.
• Experience designing innovative workforce and supervision models across multiple jurisdictions
• Experience developing multi-state regulatory matrices, collaborative or supervisory agreement frameworks, telehealth and telepresenter models, or enterprise clinical governance tools.
• Experience with telehealth, mobile clinical services, occupational-health programs, medical-disability examinations, readiness programs, or episodic-care models.
• Experience evaluating electronic health records, clinical technology, documentation systems, or digital clinical workflows
• Project-management, process-improvement, quality, compliance, legal-nurse-consulting, or healthcare-executive credentials
• Experience mentoring clinical professionals or onboarding senior clinical consultants

*All employees working remotely will berequiredto 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.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.