Clinical Practice Consultant - Las Vegas, NV

The Clinical Practice Consultant will strategically develop clinically oriented provider and community based partnerships to increase quality scores based on state-specific quality measures. The role involves ongoing management of provider practices, community education on quality measures, and coordination with quality leadership to implement an interdisciplinary approach for performance improvement. The consultant provides practice-level quality transformation through education on HEDIS/State-specific measures, assists providers in meeting state contractual requirements and pay‑for‑performance initiatives, and supports continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools.

The position requires up to 50% local travel to provider offices throughout Clark County and reports to the BHO Quality Manager and BHO Quality Leadership. Primary Responsibilities 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. Provides 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.

Serves as subject matter expert for assigned HEDIS/State Measures, leads efforts with clinical and analytical teams to research and design educational materials for use in practitioner offices, and consults with vendors to design and implement initiatives to innovate and improve HEDIS/State Measure rates. Participates, coordinates, and/or represents BHO at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs. Identifies population-based member barriers to care to develop local level strategies to overcome barriers and close clinical gaps in care.

Reports individual member quality of care concerns or trends of concern to the BHO Quality Manager. Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and documentation practices, compliance with quality metrics, and compliance with service delivery and quality standards; may also conduct additional QI audits through medical record review. Based on audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement.

Educates providers and office staff on proper clinical documentation and coding practices, state-mandated quality metrics specifications and medical record review criteria. Supports continuum of member care by identifying members in need of health education and/or services and refers providers to the appropriate internal departments for follow through. Documents and refers providers’ non‑clinical/service issues to the appropriate internal parties.

Works with providers on standards of care, advising on established clinical practice guidelines and appropriate documentation and coding consistent with state specific measures and technical specifications. Supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or other focus studies as directed by Quality Leadership. Supports quality improvement program studies with work that ranges from accessing and analyzing provider records, maintaining databases, and researching to identify members’ encounter history.

Participates in or coordinates with other department projects as needed. Required Qualifications Current and unrestricted RN license in the state of Nevada 2+ years of clinical experience Proficient in Microsoft Word Driver's License and access to reliable transportation Ability to travel locally up to 50% of the time to physician offices (Las Vegas area) Preferred Qualifications Bachelor's degree Experience with HEDIS, NCQA, governing and/or regulatory agency requirements Behavioral health experience Health care and insurance industry experience, including regulatory and compliance Proficient in Microsoft Excel and PowerPoint Ability to communicate verbally and through written communication Ability to analyze, summarize and present data and reports to committees in both verbal and written formats Ability to work in a team environment All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Benefits Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The salary for this role will range from $72,800 to $130,000 annually based on full‑time employment.

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements). We comply with all minimum wage laws as applicable. Equal Employment Opportunity UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr