Note: The job is a remote job and is open to candidates in USA. Optum Serve Health Services, part of Optum, is hiring a Senior Clinical Practice Performance Consultant for its Clinical Quality & Patient Safety function. The role provides enterprise clinical consultation and develops scalable, audit-ready approaches to clinical strategy, regulatory alignment, care-delivery models, policy governance, workforce readiness, quality, and patient safety. It also supports clinical business development, implementation, technology enablement, and continuous improvement across programs.
Responsibilities
- Provide senior-level clinical consultation for OSHS programs, enterprise initiatives, new service lines, and strategic growth opportunities
- Evaluate clinical models for safety, quality, regulatory alignment, contractual compliance, operational feasibility, scalability, and workforce readiness
- Develop and maintain enterprise clinical governance architecture, including governance charters, internal clinical standards, regulatory crosswalks, gap-assessment frameworks, evidence and artifact requirements, decision pathways, accountability structures, and implementation guidance
- Translate complex clinical and regulatory requirements into practical standards for program leadership, operations, and frontline implementation
- Identify enterprise-level clinical gaps, inconsistencies, and opportunities for standardization across programs
- Apply High Reliability Organization principles to clinical decision-making, risk identification, and continuous improvement
- Serve as the clinical SME for RFIs, RFPs, contract modifications, capture activities, solutioning sessions, and new-business development
- Interpret solicitation and contract requirements to define clinical services, care modalities, workflows, staffing models, professional qualifications, supervision structures, and quality requirements
- Conduct clinical gap and capability analyses comparing customer requirements with organizational resources, policies, infrastructure, technology, and workforce capacity
- Develop or review clinical narratives, staffing assumptions, qualification matrices, scope-of-service descriptions, transition plans, readiness requirements, and implementation strategies
- Contribute to Quality Control Plans, Quality Management Plans, clinical metrics, audit methodologies, corrective-action pathways, and performance-monitoring structures
- Identify clinical assumptions, dependencies, risks, cost drivers, and implementation requirements during proposal development and post-award transition
- Research and assess federal and state requirements affecting licensed professionals, unlicensed assistive personnel, telehealth practice, mobile care, occupational health, home-based services, and other care-delivery models
- Develop and maintain scope-of-practice standards and reference tools for physicians, advanced practice clinicians, nurses, medical assistants, emergency medical personnel, technicians, and other clinical or ancillary roles
- Evaluate permitted functions, prohibited functions, supervision requirements, delegation rules, documentation expectations, competency requirements, and jurisdiction-specific limitations
- Assess proposed staffing and workforce models against practice acts, board rules, federal authorities, contract requirements, credentialing standards, and internal policies
- Advise on compact participation, federal exceptions, telehealth licensure, OCONUS considerations, and program-specific authorization
- Develop, evaluate, and maintain governance frameworks for collaborative-practice, supervisory, delegation, and clinical-oversight relationships involving physicians, advanced practice clinicians, nurses, and other regulated professionals
- Assess state-specific agreement, filing, notification, alternate-covering practitioner, physician-availability, quality-review, and documentation requirements and support implementation with accountable enterprise partners
- Design and maintain enterprise regulatory matrices, quick-reference guides, decision tools, and state-specific implementation resources with defined source standards, review cadence, change tracking, and validation pathways
- Identify and escalate unresolved scope, licensure, credentialing, supervision, or delegation risks to the appropriate accountable function
- Lead or support the research, drafting, review, revision, standardization, and maintenance of clinical policies, procedures, standards, SOPs, work instructions, protocols, job descriptions, clinical forms, and implementation tools
- Ensure clinical documents reflect evidence-based practice, professional standards, applicable requirements, accreditation expectations, contract obligations, and operational workflows
- Coordinate interdisciplinary review with clinical SMEs, Operations, Legal, Compliance, Quality, Credentialing, Medical Directors, Enablement, and affected stakeholders
- Support document intake, assignment, version control, approval, publication, change control, archival, and periodic review
- Maintain traceability between source requirements, clinical decisions, approved standards, training, workflows, and audit tools
- Identify conflicting, duplicative, outdated, or unsupported clinical documents and recommend consolidation or remediation
- Monitor and analyze changes in federal and state healthcare requirements, professional-practice standards, public-health guidance, and accreditation expectations that may affect OSHS operations
- Conduct targeted regulatory and clinical research using authoritative primary sources
- Develop impact assessments that distinguish explicit requirements, interpretation, operational implications, risks, and recommended actions
- Evaluate changes affecting licensure, telehealth, occupational health, medication administration, laboratory services, infection prevention, medical equipment, clinical documentation, delegation, supervision, and workforce qualifications
- Translate requirements into recommended changes to policy, training, workflow, quality controls, and operational processes
- Maintain documented evidence, source citations, effective dates, jurisdictional limitations, and unresolved questions
- Monitor pending legislation, proposed regulations, board actions, compact developments, and emerging professional standards; assess anticipated impact and recommend proactive policy, staffing, contracting, training, or implementation changes
- Identify clinical, regulatory, operational, workforce, and patient-safety risks associated with current and proposed services
- Conduct or support risk assessments, gap analyses, root cause analyses, incident reviews, failure-mode evaluations, and corrective-action planning
- Evaluate the clinical implications of audit findings, documentation trends, complaints, adverse events, near misses, performance metrics, and operational variation
- Recommend risk controls, escalation pathways, monitoring methods, competency requirements, and corrective or preventive actions
- Support development of audit criteria, surveillance tools, readiness assessments, clinical dashboards, and quality indicators
- Ensure identified risks are clearly documented, assigned to an accountable owner, escalated appropriately, and monitored to resolution
- Design or evaluate workforce models for fixed-site, mobile, virtual, embedded, event-based, surge, occupational-health, and home-based services
- Define appropriate clinical roles, qualifications, staffing ratios, supervision structures, escalation coverage, competency requirements, and operational boundaries
- Assess the suitability of licensed and unlicensed personnel for proposed clinical functions
- Evaluate workforce models for patient safety, legal scope, operational feasibility, workforce availability, cost implications, and scalability
- Support development of job descriptions, role profiles, competency frameworks, interview criteria, resume-review standards, and onboarding requirements
- Advise on innovative staffing approaches while ensuring alignment with scope, licensure, policy, and contract requirements
- Evaluate telehealth, telepresenter, remote-supervision, and hybrid service models, including clinical appropriateness, physical-examination limitations, personnel qualifications, documentation standards, technology dependencies, escalation pathways, and requirements for in-person care
- Differentiate clinical requirements according to program purpose and legal structure, including treatment, occupational health, medical surveillance, disability evaluation, readiness assessment, triage, advisory, and administrative examination models
- Evaluate task-level authority and competency requirements for ancillary procedures and diagnostic services, including phlebotomy, electrocardiography, spirometry and pulmonary function testing, ankle-brachial index testing, medication-related activities, specimen handling, and telepresenter-assisted examination functions
- Define clinical learning requirements for new programs, clinical roles, policies, workflows, and regulatory changes
- Clinically review onboarding, sustainment, remediation, and annual competency content developed by Enablement or other training owners
- Ensure training aligns with approved policy, scope of practice, licensure, delegation, supervision, contractual obligations, and operational expectations
- Develop or contribute specialized clinical subject-matter content when required
- Establish clinical competency criteria, validation methods, assessor qualifications, reassessment requirements, and documentation expectations
- Evaluate training effectiveness and recommend updates based on audit findings, operational feedback, incidents, regulatory changes, and performance trends
- Provide clinical consultation for occupational health, medical surveillance, workforce health, infection prevention, exposure response, vaccination, fitness-for-duty, and employee-safety programs
- Evaluate workplace clinical protocols, employee-health workflows, medical-screening requirements, exposure risks, and field-safety considerations
- Establish or evaluate clinical standards and operational controls for medications, vaccines, laboratory and point-of-care testing, medical equipment, supplies, specimen handling, infection prevention, temperature control, emergency response resources, and regulated medical waste, including personnel authorization, competency, maintenance, quality control, documentation, and escalation requirements
- Assess clinical and workforce risks associated with mobile, home-based, remote, and field operations, including home-entry protocols, lone-worker safety, environmental hazards, emergency communication, transportation and vehicle liability, equipment and supply security, infection control, accompaniment criteria, and field-readiness requirements
- Collaborate with Environmental and Occupational Health, Operations, Legal, Compliance, and program leadership on risk mitigation and implementation
- Define clinical, documentation, safety, privacy, quality, and workflow requirements for electronic health records, clinical platforms, digital tools, telehealth solutions, and emerging technologies
- Translate clinical operations into functional business and system requirements
- Lead or support development of clinical and information-governance requirements for electronic health records and related platforms, including longitudinal record management, active and inactive diagnoses, problem-list reconciliation, continuity of care, role-based access, patient versus employer visibility, occupational-health record separation, PHI controls, audit trails, clinical decision support, and contract-specific reporting
- Participate in system selection, requirements development, workflow mapping, user-acceptance planning, implementation, and optimization
- Evaluate whether proposed technology supports safe care, regulatory compliance, contractual reporting, clinical governance, and auditability
Skills
- Bachelor's degree in nursing, healthcare, public health or healthcare administration
- Active, unrestricted Registered Nurse license, MSN, BSN, RN, NP
- 8+ years of progressive clinical, healthcare operations, quality, regulatory, program-development, or consulting experience
- Significant experience interpreting and applying federal and state healthcare requirements, professional-practice standards, clinical policy, or accreditation requirements
- Experience developing, reviewing, or implementing clinical policies, SOPs, workflows, standards, or quality-management documents
- Experience evaluating clinical scope of practice, licensure, delegation, supervision, credentialing, or professional qualifications
- Experience leading complex, cross-functional clinical initiatives in a matrixed organization
- Demonstrated ability to synthesize complex clinical, regulatory, contractual, and operational information into practical recommendations
- Demonstrated experience communicating with senior leaders, clinical SMEs, operational teams, and nonclinical stakeholders
- Advanced proficiency with Microsoft Word, Excel, PowerPoint, Teams, and SharePoint
- Ability to manage multiple high-priority assignments with competing deadlines and incomplete or evolving information
- United States citizenship is required for this position
- Ability to obtain and maintain a suitability or determination of eligibility for a Confidential/Secret or Top Secret security clearance
- Master of Science in Nursing, healthcare administration, public health, business administration, or a related advanced degree
- Executive MBA or other advanced business, strategy, or healthcare leadership education
- 10+ years of progressive clinical and healthcare leadership experience
- Experience in federal healthcare, government contracting, military health, Veterans' health, public health, occupational health, or distributed national care delivery
- Experience with RFI/RFP responses, capture activities, proposal development, clinical solutioning, Quality Control Plans, or post-award transition
- Experience with clinical governance, Joint Commission accreditation, High Reliability Organization implementation, quality improvement, or patient-safety systems
- Experience designing innovative workforce and supervision models across multiple jurisdictions
- Experience developing multi-state regulatory matrices, collaborative or supervisory agreement frameworks, telehealth and telepresenter models, or enterprise clinical governance tools
- Experience with telehealth, mobile clinical services, occupational-health programs, medical-disability examinations, readiness programs, or episodic-care models
- Experience evaluating electronic health records, clinical technology, documentation systems, or digital clinical workflows
- Project-management, process-improvement, quality, compliance, legal-nurse-consulting, or healthcare-executive credentials
- Experience mentoring clinical professionals or onboarding senior clinical consultants
Benefits
- You'll enjoy the flexibility to work remotely from anywhere within the U.S.
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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