UnitedHealthcare ยท 21 hours ago
Clinical Practice Consultant - Oahu / Kauai, HI
Honolulu, HI
Full-time
Hybrid
Mid Level
$28.27/hr - $50.48/hr
3+ years expUnitedHealthcare is focused on simplifying the health care experience and creating healthier communities. They are seeking a Clinical Practice Consultant to educate providers on clinical documentation and quality metrics, support quality improvement initiatives, and coordinate clinical evaluations while working closely with healthcare providers.
FitnessHealth CareWellness
Responsibilities
Educates providers and office staff on proper clinical documentation, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS/State Specific quality measures for provider and staff education during field visits
Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating, and facilitating on a local level)
Serves as subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates
Participates, coordinates, and/or represents the Health Plan at community-based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards
Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
Supports continuum of member care by referring members to the appropriate internal departments per policy as needs arise
Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation consistent with state specific measures and technical specifications
Other duties as assigned
Qualification
Required
3+ years of health care related experience
2+ years of experience in managed care or equivalent healthcare experience, including regular interaction with providers regarding clinical quality improvement processes
Proficiency using a PC in a Windows environment, including Microsoft Outlook, Word, Excel, and PowerPoint
Ability to Travel to physician offices locally up to 75% of the time in Hawaii
Access to reliable transportation, and proof of automobile insurance
Preferred
Current unrestricted RN or MSW licensure in the State of Hawaii
Experience working in Medicaid and/or Medicare
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
Experience in managed care
Multilingual
Account Management experience
Experience working with behavioral health patients, members, or providers
Proven presentation skills with experience and comfortability presenting to others
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
UnitedHealthcare
UnitedHealthcare helps people live healthier lives by simplifying the health care experience.
10001+ employees
H1B Sponsorship
UnitedHealthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (48)
2024 (26)
2023 (45)
2022 (61)
2021 (60)
2020 (68)
Funding
Current Stage
Late StageLeadership Team
R
Rebecca Madsen
Chief Consumer Officer
Recent News
2026-01-16
2026-01-16
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