[Remote] Senior Clinical Practice Performance Consultant

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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