Value Based Program Consultant - Maryland
About the Job
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
The Value Based Program Consultant (VBPC) is responsible for the ongoing clinical management and quality oversight of the Maryland Behavioral Health Home (BHH) Program. The VBPC will be responsible for developing relationships with Behavioral Health Home providers, driving a quality improvement process to improve quality, improve clinical outcomes, increase efficiency and reduce overall benefit expense. The VBPC will monitor Provider performance and compliance with contractual obligations, provide tools to assist with performance and compliance, and is accountable for driving performance improvement. As the single point of clinical contact for a practice, the VBPC will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within Optum and the Provider.
The VBPC 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 VBPC will work closely with Care Advocacy Operations, Affordability, Network Management teams and other relevant departments to affect desired outcomes with contracted Providers as it relates to treatment for our membership.
- Build and effectively maintain relationship with the Provider leadership and key clinical staff
- Conduct Provider program audits and provide feedback and results
- Deliver education and training
- Facilitate oversight meetings as needed with the Provider to monitor, present, and discuss performance
- Monitoring 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 agencies to initiate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with contractual obligations
- Initiate and monitor Performance Improvement Plans to drive performance
- Monitor and report effectiveness of interventions
- Modify interventions as appropriate
- Support those high performing agencies such that performance remains at a high level
- Provide clinical and care coordination support
- Interface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement.
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.
- Independently Licensed, Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D./Psy.D. Level Psychologist or Registered Nurse.
- Licenses must be active and unrestricted in the state of Residence
- Experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
- Experience identifying performance improvement opportunities and influencing quality metrics
- Demonstrated experience leading groups and strong presentation skills
- Strong relationship building and influencing skills
- Strong written and verbal communication skills
- Solid computer skills at the intermediate level, proficiency with MS Office
- Ability to balance contractual and clinical considerations
- Willingness to travel approximately 25% for face to face meetings
- Excellent time management and prioritization skills
- 3 years of Managed Care and/or Utilization Review experience in a Managed Care setting is highly preferred with experience working with facility/group based care advocacy.
- 3 years (POST- LICENSURE) direct behavioral health clinical experience
- Working knowledge of Public Sector benefit plans
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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: Auditor, audit, Behavioral Health, Value-based program, LPC, LCSW, LMFT, RN, LSW, Licensed Ph.D./Psy.D. Level Psychologist, Maryland, medical records, Telecommute