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UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Senior Clinical Transformation Consultant (Senior CTC) is responsible for the ongoing clinical management of physician practices participating in UnitedHealthcare’s (UHC) Accountable Care Organizations (ACO), Value Based Programs, and other Population Health Programs. We are committed to a patient centric care model. The Senior CTC will lead multi-disciplined practice transformation and practice performance improvement initiatives. The selected candidate will guide practices in achieving targeted goals that include improved quality, efficiency and utilization. The Senior CTC is accountable for driving practice progress toward desired transformational change and performance improvement, while meeting savings goals set for the practice.

The Senior CTC will act as a mentor to other Transformation Consultants on the team, will be a leader on special projects, function as a SME for internal team members and matrix partners and will work independently with minimal supervisory oversight.  As the single clinical point of contact for a practice, the Senior CTC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within UnitedHealthcare and at the practice.

If you are located within a commutable, driving distance of New Jersey or New York downstate areas, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Will be accountable for oversight and management of more complex and innovative customer relationships
  • Manage a small portfolio of innovative complex customer relationships
  • Act as mentor to other Transformation Consultants
  • Leader on special projects
  • Function as a SME for internal team members and partners on quality, technology tools, clinical programs and initiatives
  • Will act independently with minimal supervisor oversight
  • Accountable for successful deployment of UHC’s Clinical Support program at the practice level, including but not limited to, introducing and educating practices on the value / use of reporting tools, patient registries and delivery of reports via UHC’s Physician Portal
  • Accountable at a practice and market level, including but not limited to, educating practices about quality and utilization opportunities, program components and updates, and Case Management liaison
  • Build and effectively maintain relationship with the practice leadership and key clinical influencers actively involved in practice transformation
  • Support of clinical data and interoperability exchanges via available health information exchanges and market-wide platforms.
  • Regularly facilitate efficient, effective practice improvement meetings with the practice to monitor, present, and discuss progress on the transformation action plan and achievement in milestones
  • Develop strategies; based on performance analysis, for improvement that includes specific outcomes and metrics to monitor progress to a goal and make recommendations for improvement
  • Design practice transformation action plans and implement appropriate performance improvement initiatives designed to assist the practice in achieving contractually required transformation milestones
  • Monitor and review the progress of the practice in milestone achievement and ensure the practice is accountable for successful completion
  • Use data to analyze key cost, utilization and quality data and interpret results to assess the performance of the practice
  • Use data to analyze trends and work with stakeholders to agree on and implement proactive strategies to address issues, and measure impact using a PDSA rapid cycle improvement approach; including external practice data
  • Assist practices in creating workflows to optimize care delivery, introduce best practices improvements, and evaluate outcomes using rapid cycle improvements PDSA methods to reach mutual goals
  • Educate & Deploy technology tools to support Practice Transformation
  • Integrate technology tools into practice workflows
  • Build and effectively maintain relationships with team members in the UHC Clinical organization as well Medical Directors, local Network leads, Health Care Economic Analysts and Clinical Analysts in support of the program
  • Consult and partners with internal UHC matrix partners and the practice to identify organizational and structural challenges hindering achievement of desired program outcomes
  • Collaborate with UnitedHealthcare teams including the practice Care Coordinators, quality management teams, hospital clinical teams, behavioral health teams to support integrated PCP driven care for our members with practices and hospitals
  • Consult and guide the practice on developing innovative solutions, including bringing best practice experience and connecting practices with other high performing practices to spur innovation
  • Work with the practice and Optum to align and integrate Optum care / disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
  • Assist and support department leaders in summarizing and disseminating experience - related learning’s by way of team updates, written reports / articles, and / or presentations as called for by directors

You’ll be 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 as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor’s degree or equivalent combination of education and relevant work experience
  • 5+ combined years of experience with improving clinical quality, establishing best practices, health care analytics, or driving clinical transformation initiatives with population health programs, Patient Center Medical Homes, Accountable Care Organizations OR 5+ years in Healthcare Administration, Business or other related field of study
  • 4+ years of working with providers on HEDIS and STAR measures, clinical quality measures, CAHPS / HOS, or other value-based quality measures
  • 3+ years demonstrated ability to drive relationships and clinical engagement with ACO, Health Homes or health system leadership and their key clinical influencers
  • 2+ years of experience interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
  • Medicaid Managed Care experience
  • Experience preparing and presenting information to clinical and executive level leadership
  • Strong Microsoft Office Skills with Word, Excel, Outlook and PowerPoint
  • Access to high speed internet for home office set up
  • Willingness to travel up to 50% of the time for face to face meetings, based on market specific needs (Travel will be within the New York & New Jersey markets)
  • Reside in or within a commutable driving distance to area to accommodate same day, in market travel requirements
  • Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area (markets may require valid driver’s license)

Preferred Qualifications:

  • Master’s Degree
  • Certified Risk Coder (CRC) preferred or in process of completion with 1+ years of experience
  • Active, unrestricted RN license in the State of Residence
  • Physician practice experience
  • Demonstrated experience implementing clinical practice transformation initiatives designed to help provider or hospital groups achieve large-scale health transformation goals
  • Medicaid, Medicare and/or Commercial experience
  • Experience using a PDSA rapid cycle improvement approach
  •  Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

 

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.
 

Job Keywords: Sr. Clinical Practice Peformance Consultant, New Jersey, Newark, NJ, New York, Long Island, NY

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Sr. Clinical Transformation Consultant - NJ or NY Downstate Area