Clinical Practice Consultant (Philadelphia, PA)

Position Summary:

This position is responsible for working with physician practices to improve HEDIS scores and meet managed care crieteria. As a Clinical Practice Consultant, you will be going out to physician practices four days a week working to improve HEDIS scores. In addition, you will also be involved in annual HEDIS abstraction from the beginning of March to the end of June. Additional projects as needed, consisting of community outreach.

• Work with physician practices on a regular basis to improve HEDIS scores
• HEDIS abstraction
• Performing chart audits
• Acts as a liaison as necessary to the company for Quality issues interacting with Finance, Pharmacy, Special Needs Unit, etc with cyclical inservicing for the Utilization Management and Member Services Departments.
• Works closely with Compliance Officer.
• Participates and/or coordinates in other departmental projects as needed or required.
  

Qualifications:

• Unrestricted RN license in the state of PA required
• 5 years of clinical experience required (preferably Medical-Surgical)
• Chart auditing experience
• Ability to use sound judgment using solid nursing principles and processes to analyze potential Quality of Care/Risk Issues.
• Computer Proficiency
• Ability to organize and maintain multiple projects
• Possesses effective interpersonal skills
• Communicates in a professional manner with members, physicians, and staff.
• Willingness and ability to travel; current Pennsylvania driver?s license with reliable personal vehicle

Additional Assets Preferred:

• Managed Care experience
• HEDIS or NCQA
• Exposure and experience with CPT coding

AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.


You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.


Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

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.