9 days old

Sr. Clinical Practice Consultant - Telecommute - 930721

San Diego, CA 92101 Work Remotely
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  • Job Code
    930721

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)

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The Sr. Clinical Practice Consultant (CPC) is responsible for the ongoing clinical management of Community Based practices participating in UnitedHealthcares (UHC) Health Home Programs for Medi-Cal. The HHTC will lead multi-disciplined practice transformation and practice performance improvement initiatives. The selected candidate will guide practices in achieving targeted goals that include oversight of care management programs and achieving Centers for Medicaid and Medicare (CMS) prescribed Six Health Home Core Services. The CPC is accountable for driving practice progress toward desired transformational change and performance improvement, while meeting savings goals set for the practice.

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The Six Health Home Core Services are:

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  • Care Coordination - Cross system care coordination activities to assist participants in accessing and navigating needed services
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  • Care Transitions - Proper and Timely follow-up care to prevent avoidable readmission after discharge from an ER and inpatient facilities
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  • Referral Management - Identification of available community-based resources and actively managing referrals, assistance to the beneficiary in advocating for access to care and engagement with community and social supports related to goal achievement documented in the Health Action Plan (HAP) through the use of information technology services
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  • Health Promotion - Begins with the commencement of the Health Action Plan (HAP), demonstrating use of self-management, recovery and resiliency principles using person-identified supports. Addressing gaps in care
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  • Individual Support - Support the beneficiary to access and navigate the healthcare and social service delivery system as well as support health action planning
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  • Family/Caregiver Support - Support to the beneficiarys family and/or caregiver to access and navigate the healthcare and social services delivery systems as well as support health action planning
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As the single point of clinical contact for a practice, the CPC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within UnitedHealthcare and at the Community Based Provider.

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If you are located within commutable driving distance from the San Diego, CA area, you will have the flexibility to work from home/ telecommute* as you take on some tough challenges.

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Primary Responsibilities:

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  • Accountable for successful deployment of UHCs Clinical Support program at the practice level, including but not limited to, introducing and educating practices on the interpretation of data, closing care gaps, and ensuring social determinants of health are addressed.
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  • Build and effectively maintain relationship with the Community Based organizational leadership and key clinical influencers actively involved in practice transformation
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  • Regularly facilitate efficient, effective practice improvement meetings with the Community Based Provider to monitor, present, and discuss progress on the transformation action plan and achievement in milestones
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  • 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
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  • Where outcomes are below goal, the CPC will identify outlier member files for focused action plans and/or clinical case round review
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  • Audit of Health Home assessments and member care plans to ensure compliance with regulatory requirements and policies and procedures
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  • Use data to analyze trends and work with stakeholders to agree on and implement proactive strategies to address issues, and measure impact using a Plan-Do-Study-Act (PDSA) rapid cycle improvement approach; including external practice data
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  • Educate, train and deploy technology tools to support Practice Transformation
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  • Consult and partner with internal UHC matrix partners and the practice to identify organizational and structural challenges hindering achievement of desired program outcomes
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  • 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
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  • Ensure all required member documents as indicated in the Community and State UnitedHealthcare contract for Health Home and future Enhanced Care Management programs
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Youll 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.

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Required Qualifications:

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  • Bachelor's degree or equivalent relevant experience
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  • Active, unrestricted license as a Social Worker or Mental Health Professional (LMHC, LCSW, LMSW, LMFT, LMHP, CASAC, etc.) in the State of California
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  • 5+ years of combined experience with improving behavioral health quality
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  • Demonstratable knowledge of community-based resources in San Diego County
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  • Experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
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  • Demonstrated experience leading groups and strong presentation skills
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  • Solid Microsoft Office Skills with Word, Excel, Outlook and PowerPoint
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  • Sound relationship building skills with internal and practice teams to drive goal alignment
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  • Willingness to travel up to 25% for face to face meetings within the San Diego, CA and surrounding areas
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  • Reside within commutable driving distance from San Diego, CA
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  • Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area (valid drivers license)
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • Master's Degree
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  • Certified Case Manager (CCM)
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  • Demonstrated experience implementing Clinical Practice Transformation initiatives designed to help provider or hospital groups achieve large-scale health transformation goals
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  • Community Safety Net Provider Systems of Care experience
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Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10organization 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)

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy

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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.

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UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Clinical Practice Consultant, Certified Case Manager, Health Homes, Behavioral Health, Provider Relations, Social Worker, Case Management Certification, Implementation, Quality Improvement, Performance Improvement, Health Care Analytics, Managed Care, Healthcare, Medi-Cal, San Diego, CA, California, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

Posted: 2021-06-04 Expires: 2021-07-04

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Sr. Clinical Practice Consultant - Telecommute - 930721

UnitedHealth Group
San Diego, CA 92101

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