Provider Enablement Consultant Rn Or Licensed Behavioral Health Clinician Florida - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Provider Enablement Consultant (PEC) is responsible for the ongoing clinical management and quality oversight of Optum’s value-based programs. The PEC will be responsible for developing relationships with participating Integrated Behavioral Health Home providers, 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.

If you are a Florida resident, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

• Identify performance improvement opportunities through analysis of operational data, clinical outcome data and utilization/claims data
• Conduct provider program audits and provide feedback and results
• Communicate with providers to initiate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with contractual obligations
• 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.
• Regularly facilitate oversight meetings with the provider to monitor, present, and discuss performance
• Modify interventions as appropriate
• Monitoring provider performance on program metrics, quality outcomes and adherence to contract requirements
• Initiate and monitor Quality Improvement Plans to drive performance
• Deliver education and training
• Monitor and report effectiveness of interventions
• Support those high performing providers such that performance remains at a high level
• Build and effectively maintain relationship with the provider leadership and key clinical staff

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:

• Independently licensed behavior health clinician including RN with behavioral health experience or LISW, LICSW, LPC, LPCC, LMFT, PsyD
• Demonstrated experience leading groups and solid presentation skills
• Experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
• License must be active and unrestricted in state of residence
• Experience identifying performance improvement opportunities and influencing quality metrics
• Solid computer skills at the intermediate level, proficiency with MS Office

Preferred Qualifications:

• 3+ years of Managed Care and/or Case Management 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
• Proven solid relationship building and influencing skills
• Demonstrated ability to balance contractual and clinical considerations
• Residence in Florida
• Working knowledge of Public Sector benefit plans
• Proven solid written and verbal communication skills
• Proven excellent time management and prioritization skills

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.