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Sr. Clinical Quality Analyst - Arizona - Virtual

Company: UnitedHealth Group
Location: Scottsdale
Posted on: May 25, 2023

Job Description:

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)
Do you enjoy working with both providers and members to address care gaps? Become part of our team and build high value relationships with providers in assigned areas to drive member health outcomes. Proactively identify issues that hinders provider relationship with plan. Continuously look for innovative channels to engaging both members and providers at a higher level.
If you are located in Arizona - 25% travel in state, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

  • Support STARS improvement projects, HEDIS, CAHPS measures and provide clinical guidance

  • Monitor of reports and playbook

  • Support National Team efforts

  • Educate providers on general policies and procedures applicable to delivery of care

  • Educate providers on proper HEDIS documentation/coding for member compliance

  • Conduct regular visits to providers to introduce new initiatives and monitor success of those in place and to identify issues and ensure effective problem resolution to maintain solid relationships

  • Serves as the primary point of contact, consultative resource, and subject matter expert in all aspects of medical record documentation requirements and coding as they apply to CMS Stars/HEDIS measures

  • Closely working with internal stakeholders and providers to engage members and close care gaps

  • Regularly checking Practice Assist for inpatient stay members, notifying provider and/or scheduling telehealth visit with provider for member

  • Weekly and monthly productivity reports for outreach (Corral, Provider Letter campaign, Compassion Cards)

  • Member/Provider outreach to address care gaps. Following up with provider (fax, email, mail, phone call, face-to-face)

  • Identify and implement opportunities to improve rates or efficiency of data collection

  • Ensure projects are completed on time and in scope

  • Support Health Plans as Subject Matter Expert of STARS and HEDIS Technical Specifications, project plans, and reporting logistics

  • Support the evaluation and monitoring of State specific QM Metrics

  • Need to work independently and within an integrated team in a highly matrixed environment

  • Attend weekly/monthly and ad hoc Webex meetings with national partners (National Star Operations Meetings, Stars Measure Meetings, and Various measure groups, etc.)

  • Travel locally in Arizona (50 -75%) to meet with provider groups and healthcare quality or policy organizations

    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:

    • Registered Nurse with no restrictions in Arizona required to practice

    • 3+ years of experience working in a healthcare environment

    • 3+ years of experience of project management

    • 3+ years of experience in tracking, working with large data sets and making data-driven analytical decisions

    • Experience working with provider relations

    • Intermediate or higher level of proficiency with Excel and PowerPoint, including visual representation of quality data and trends, use of basic math and statistics functions

    • Proven flexibility and quick adaptation to change is key

    • Proven continuous improvement mindset

    • Access to reliable transportation with valid driver's license that will enable you to travel to client and/or sites within designated area

    • Candidate must be based in Arizona (Phoenix, Tucson, or Mesa)

    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

      Preferred Qualifications:

      • 2+ years of Medicare, DSNP Lines of business

      • 2+ years of Stars, HEDIS measure technical specifications

      • UnitedHealth Group, Optum, or UnitedHealthcare experience

      • Community & State and or Medicare & Retirement experience

      • Demonstrated ability to communicate ideas clearly and concisely

      • Proven excellent time management, organizational, and prioritization skills and ability to balance multiple priorities

        To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
        Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
        *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.

Keywords: UnitedHealth Group, Scottsdale , Sr. Clinical Quality Analyst - Arizona - Virtual, Professions , Scottsdale, Arizona

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