UnitedHealth Group Sr. Health Home Transformation Consultant - Seattle, WA in Seattle, Washington

The Senior Health Home Transformation Consultant is responsible for the oversight of the clinical team management of physician practices participating in UnitedHealthcare’s (UHC) Health Home Programs for Community and State. This position will ensure systems are in place for optimal multi-disciplined practice transformation and practice performance improvement initiatives. The selected candidate will establish and improve practices in achieving targeted goals that include improved quality, efficiency and utilization and achieving Centers for Medicaid and Medicare (CMS) prescribed Six Health Home Core Services. This position is accountable for driving performance toward desired program affordability targets and contract compliance, while achieving operational excellence.

The Six Health Home Core Services are:

  • Care Coordination - Cross system care coordination activities to assist participant’s in accessing and navigating needed services

  • Care Transitions - Proper and Timely follow-up care to prevent avoidable readmission after discharge from an ER and inpatient facilities

  • 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

  • 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

  • Individual Support - Support the beneficiary to access and navigate the healthcare and social service delivery system as well as support health action planning

  • Family / Caregiver Support - Support to the beneficiary’s family and / or caregiver to access and navigate the healthcare and social services delivery systems as well as support health action planning

As the operational lead, this position will be responsible for leading achievement of targeted goals to Senior Leadership both within UnitedHealthcare and at the practice.

Primary Responsibilities:

  • Develop and deploy meaningful performance measures and data reporting 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 Technology Portals

  • Develop and maintain strategic stakeholder and community based relationships with the Health Home providers, members and leaders

  • Lead and structure efficient, effective practice improvement meetings with the practice to monitor, present, and discuss progress on the transformation action plan and achievement in milestones

  • Design innovative and cost efficient approaches to Medicaid affordability

  • 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 insure the practice is accountable for successful completion

  • Develop performance improvement plans and corrective action plans

  • Lead system improvement projects and initiatives

  • Audit of Health Home assessments and member care plans to ensure compliance with regulatory requirements

  • 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 Plan-Do-Study-Act (PDSA) rapid cycle improvement approach; including external practice data

  • Educate & Deploy technology tools to support Practice Transformation

  • 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 partner 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 whole person care for our members with practices and hospitals

  • 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

  • Ensure all required member documents as indicated in the Community and State UnitedHealthcare contract for Health Home programs

Required Qualifications:

  • Bachelor's Degree

  • 5+ combined experience with improving clinical quality, health care analytics, or driving clinical transformation initiatives with population health programs or utilization review in a Managed Care setting

  • 3+ years in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change.

  • Experience working with and collaborating successfully with senior level leadership.

  • Demonstrated experience leading groups and strong presentation skills

  • Strong Microsoft Office Skills with Word, Excel, Outlook and PowerPoint

  • Strong Relationship building skills with internal and practice teams to drive goal alignment

  • Willingness to travel up to 50% for face to face meetings throughout the State of Washington

  • Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area

  • Designated quiet work space and access to install secure high speed internet via cable/DSL in home

Preferred Qualifications:

  • Master's Degree

  • Active, unrestricted RN license in the State of Residence or Social worker with CCM certification

  • Behavioral Health experience

  • Active, unrestricted Behavioral Health related licensure

  • Demonstrated experience implementing Clinical Practice Transformation initiatives designed to help provider or hospital groups achieve large-scale health transformation goals

  • Community Safety Net Provider Systems of Care experience

  • Certified Case Manager (CCM)

  • 4+ years’ experience operationalizing start-ups

  • Residency in the State of Washington to support local market travel needs

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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)

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: RN, registered nurse, certified case manager, health homes, provider relations, social worker with case management certification, implementation, quality improvement, performance improvement, health care analytics, managed care, healthcare, community