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Clinical Practice Consultant - New York City - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | New York, NY New York, New York |
About this job
Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)
This position is responsible for ongoing HEDIS collection and improvement activities. The Clinical Practice consultant will coordinate and perform onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards, and where assigned investigation of quality of care and member complaints relative to quality of care and service.
- Support continuum of member care by identifying members in need of health education, case management, etc.
- Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria.
- Solicit identification of barriers the office faces in providing care to members.
- Supports the HEDIS medical record chase to support optimum HEDIS and quality metric reporting.
- Supports quality improvement program studies requesting records from providers, maintaining databases, and researching to identify members' provider encounter history
- Participates in and represents plan at community, health department, collaborative and other organizational meetings focusing on quality improvement, member education, and disparity programs, as assigned
- Performs annual medical record evaluation, follow-up education, practitioner intervention, measurement (QI 13) as required
- Enter documentation of findings in identified database
- Participates in or coordinates with other department projects as needed
Requirements
- RN or LPN with current licensure and/or extensive Physicians practice management experience.
- Minimum 3 years clinical experience preferable with practice experience
- Experience working in Medicare, including regulatory and compliance requirements
- Ability to travel to physician offices; valid state-specific driver's license and reliable vehicle.
- Proficiency in software applications that include, but are not limited to, Microsoft Word and Microsoft Excel.
Preferred/Asset Qualifications
- 1 year quality improvement experience
- Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry.
- Strong organizational skills and ability to work both independently and with teams.
- Ability to evaluate medical records with attention to detail.
- Ability to interact with medical staff, peers, and internal company staff at all levels.
- Ability to make formal presentations in front of committee and work group environments.
- Ability to use databases and prepare reports as needed
- BSN Preferred
- Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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