Clinical Practice Consultant

Website UnitedHealthcare

The Clinical Practice consultant is responsible for completing auditing and/ or medical records review projects. Primary responsibilities will include data/ medical record collection (including outreach to provider offices) and medical record review. Additional responsibilities may include chart abstractions, reporting and analyses.

If you are located within a 1 hour commute to Warwick, RI, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Schedule and confirm individual appointments at provider offices/ facilities to access, review, and collect medical records that meet required HEDIS Technical Specifications
Visit provider offices/ facilities to retrieve specific documents from medical records that meet required HEDIS Technical Specifications
Scan and /or copy medical records as part of the retrieval process
Facilitate the transfer of files to a secure file transfer site daily
Participate in web-based trainings upon hire
Complete and receive a passing score for all required training, testing and assessments
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:

Undergraduate degree or equivalent experience (in healthcare data analytics, quality)
Certified Professional in Healthcare Quality (CPHQ) Certification (if not already certified, commitment to get certified within the first 24 months of hire)
3+ years of Clinical Quality experience
3+ years of HEDIS experience
3+years of Medical record review experience
3+ years of Provider and/ or Accountable Care Organization (ACO) outreach
3+ years of Data analysis (able to identify trends and opportunities for improvement)
Reliable transportation, auto insurance and a valid driver’s license
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Preferred Qualifications:

Intermediate skills in Microsoft Word and Microsoft Excel (experience with combining and creating documents in Adobe Acrobat also preferred)
Experience interfacing with United Health Services personnel and contracted providers/ physicians and their office staff
Intermediate skills and willingness to learn how to use website portals/ processes for exchange of information
High-speed internet access at home (no dial-up)
Able to work well as part of a team and independently
Able to travel to medical facilities/ provider offices to complete record reviews within a 40-mile radius

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