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This position is responsible for strategically developing and managing clinically oriented provider and community based partnerships in order to meet requirements of the Care Management for At-Risk Children (CMARC) and Care Management for High-Risk Pregnancy (CMHRP) programs on state specific guidelines. This role will be responsible for monitoring and providing ongoing oversight of the Local Health Department (LHD) CMARC and CMHRP programs. Additionally, this role will work in concert with the Advanced Medical Home (AMH) Clinical Practice Consultants where the LHD intersects with Advanced Medical Home (AMH) Tier 3 program requirements.The Clinical Practice Consultant will work closely with the Health Plan Clinical Leadership to coordinate an interdisciplinary approach to increase programmatic and practice performance. This position will guide LHD in achieving CMARC/CMHRP program requirements through: oversight & performance monitoring, relationship management & engagement, education, and quality improvement. This position is accountable for driving program and practice progress toward desired transformational change and performance improvement, while meeting CMARC/CMHRP program expectations outlined by the state. Position reports to the Maternal and Child Health 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 maternal and child health within the AMH programs.If you are located in Raleigh/Durham, you will have the flexibility to telecommute as you take on some tough challenges.Primary Responsibilities:
Provide oversight and performance evaluation through continuous monitoring and analysis of CMARC/CMHRP program requirements and development of strategies based on performance analysis
Regularly facilitate efficient, effective meetings with the program to monitor, present, and discuss progress towards program requirements
Provide ongoing support and develop recommended actions and best practices to assist LHD providers and CMARC/CMHRP in achieving contractual requirements
Utilize monitoring and audit tools to review progress of the LHD AMH Tier 3 requirements and insure the practice is accountable for successful implementation
Build and effectively maintain relationships with program and LHD 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)
Collaborate with DHHS and DPH leadership for CMARC/CMHRP programs to ensure appropriate policies, processes, oversight and outcomes
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 principlesto provide technical assistance and support to improve CMARC/CMHRP program and LHD 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 CMARC/CMHRP program and LHD practice needs, 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
Required Qualifications:
Bachelor’s Degree in healthcare related field or business combined with two years of equivalent work experience
3+ years of experience working with population health and local health departments
2+ years of experience with responsibilities in the following areas: 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 of experience working with high-risk children and/or high-risk pregnancy populations.
2 + years of experience working with the Medicaid population
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
Preferred Qualifications:
CCM
Program oversight experience
Graduate degree preferred
Knowledge of one or more of: clinical standards of care, HEDIS, NCQA PCMH, and governing and regulatory agency requirements
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work. SMAll Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter PolicyDiversity 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: Local Health Department, LHD, analyst, quality, auditing, Clinical Practice Consultants, CPC performance measures, medical practices, care management, quality improvement, Plan-Do-Study-Act, (PDSA), travel, data, reporting, healthcare, insurance, Medicaid, Medicare, managed care, systems analysis, graphical display of data, CPHQ, CCM, clinical standards of care, HEDIS, NCQA, PCMH, governing, regulatory agency, High-Risk Pregnancy, At-Risk Children (CMARC), Maternal and Child Health, Care Management, North Carolina, NC
