This position is responsible for strategically developing and managing clinically oriented provider and community based partnerships in order to meet requirements of the Advanced Medical Home (AMH) Tier 3 program based on state specific guidelines. This role will be responsible for monitoring and providing ongoing oversight of the AMH Tier 3 program requirements of provider practices. This role will work in concert with the Local Health Department (LHD) Clinical Practice Consultants.
The Clinical Practice Consultant will work closely with the Health Plan Clinical Leadership to coordinate an interdisciplinary approach to increase provider and program performance. This position will guide practices in achieving AMH Tier 3 program requirements through: oversight & performance monitoring, relationship management & engagement, education, and quality improvement. This position is accountable for driving practice progress toward desired transformational change and performance improvement, while meeting AMH program expectations outlined by the state. Position reports to the AMH Transformation Director.
The Clinical Practice Consultant will be assigned to a specified Medicaid region within North Carolina. This is a work from home / telecommute position when not in the field but may require travel to State sponsored meetings and to the Greensboro or Raleigh office.
The Advanced Medical Home program was developed by NC DHHS as the primary vehicle for delivering care management as the state transitions to Medicaid managed care. The AMH program builds on the Carolina ACCESS program. The tiers include Tier 1, Tier 2 and Tier 3: This position will focus on AMH Tier 3.
If you are located in Greenville,, you will have the flexibility to telecommute* as you take on some tough challenges.
Drives execution of clinical practice transformation by overseeing timely and successful deployment of AMH program
Provide oversight and performance evaluation through continuous monitoring and analysis of AMH Program requirements and development of strategies based on performance analysis
Regularly facilitate efficient, effective meetings with the practice to monitor, present, and discuss progress towards program requirements
Provide ongoing support and develop recommended actions and best practices to assist the practice in achieving contractual requirements
Utilize monitoring and audit tools to review progress of the AMH Tier 3 requirements and insure the practice is accountable for successful implementation
Build and effectively maintain relationships with the practice leadership and key clinical influencers actively involved in practice transformation through strategic partnerships
Serve as liaison and clinical resource using proven interpersonal and collaboration skills to foster relationships and maintain communication with multiple disciplines (e.g. Clinically Integrated Networks (CINs), internal UHC teams, external stakeholders, and other partners as appropriate)
Consult and partner with internal UHC matrix partners and the practice to identify organizational and structural challenges hindering achievement of desired program outcomes
Provide education to promote quality and cost-effective outcomes around: AMH program requirements, dissemination of the latest information on effective practices, and utilization of tools and resources to meet needs of the population (e.g. best practice guidelines, practice management support, population health program implementation, and/or with other appropriate resources)
Implement basic quality improvement principles to provide technical assistance and support to improve practice performance while assessing trends in quality measures and identifying opportunities for quality improvement (e.g. AMH identified quality measures, pay for performance measures)
Uses a systematic approach to identify practice needs and opportunities, perform data analysis, and develops actionable solutions to improve quality outcomes
Assist practices with analyzing and interpreting data to quickly identify problems, patterns, and high-risk activities
Facilitate discussions around different data visualization strategies, including differences in databases, and basic data sharing and management of resources
Cross-collaborate with the quality team for any identified or ongoing practice needs that require the involvement of a subject matter expert
Facilitates and participates in Joint Operational Committee with external care management partners
Participates, coordinates, and/or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events as assigned
Bachelor’s Degree in healthcare related field or business combined with two years of equivalent work experience
5+ years clinical experience working with primary care practices, providing provider and liaison support
3+ years experience working with population health, patient centered medical homes (PCMH) and/or practice transformation efforts
2+ years of quality improvement experience with responsibilities in the following areas rapid cycle change, data analysis and interpretation, systems analysis, graphical display of data/information, public speaking, group leadership and facilitation, and demonstrated problem solving and critical thinking skills
2+ years experience working in Medicaid and/or Medicare or the managed care industry
Previous experience in Health care and/or insurance industry experience, including regulatory and compliance
Intermediate experience in software applications skills that include, Microsoft Word, Excel, PowerPoint
Must be comfortable with creating presentations and working with data to formally present information to physicians, administrators, other providers and community partners, engaging different types of learners in various settings (e.g. practice offices, CIN/other partner offices, community settings
This role requires travel to locally up to 75% of the time and may require travel up to 2 hours away from your residence on occasion
CPHQ or CCM
Knowledge of one or more of:
clinical standards of care, HEDIS, NCQA PCMH, and governing and regulatory agency requirements
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- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
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