[Hiring] Provider Enablement Consultant @UnitedHealth Group

Role Description

The Provider Enablement Consultant (PEC) is responsible for the ongoing clinical management and quality oversight of Optum Behavioral Health’s value-based programs. The PEC will be responsible for developing relationships with participating behavioral health providers and facilities, and driving a quality improvement process to improve quality, improve clinical outcomes, increase efficiency and reduce overall benefit expense. The PEC will monitor provider performance and compliance with contractual obligations, provide tools to assist with performance and compliance, and is accountable for driving provider performance improvement. As the single point of clinical contact for a provider, the PEC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within Optum and the participating provider.

The PEC must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume facilities/groups and/or providers. This PEC will work closely with Care Advocacy Operations, Affordability, Network Management teams and other relevant departments to affect desired outcomes with the participating provider as it relates to treatment for our membership.

Location: You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Dedicated work from home space is required.

Schedule: Monday-Friday, 8am-5pm in time zone of residence. Flexibility may be required to work outside of standard business hours, depending on business need.

Primary Responsibilities:

• Build and effectively maintain relationships with provider leadership and key clinical staff
• Regularly facilitate oversight meetings with providers to monitor, present, and discuss performance
• Monitor provider performance on program metrics, quality outcomes and adherence to contract requirements
• Identify performance improvement opportunities through analysis of operational data, clinical outcome data and utilization/claims data
• Communicate with providers to initiate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with contractual obligations
• Initiate and monitor Quality Improvement Plans to drive performance
• Conduct provider program audits and provide feedback and results
• Support high performing providers such that performance remains at a high level
• Provide clinical and care coordination support
• Deliver education and training
• Interface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement

Qualifications

• Active and unrestricted Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D/Psy.D. level Psychologist, OR Bachelor's level RN (licensure must be in state of residence)
• 3+ years of post-licensure direct behavioral health clinical experience
• 1+ years of experience in a managed care setting
• 1+ years of experience performing analysis, reporting, and data analytics within healthcare, Medicaid, and/or health & human services environment
• Intermediate level of proficiency with Microsoft Office (Excel required)

Requirements

• Working knowledge of Public Sector benefit plans
• Experience identifying performance improvement opportunities and influencing quality metrics
• 3+ years of Managed Care experience
• Ability to balance contractual and clinical considerations
• Strong relationship building and influencing skills
• Strong written and verbal communication skills
• Excellent time management and prioritization skills

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)