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 to start Caring. Connecting. Growing together.

The Clinical Quality Analyst will be responsible for direction and guidance on clinical quality improvement and management programs including provider value-based care strategies. Conducts clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans, programs, and participation in implementation to support continuous quality improvement using HEDIS and other tools.

Schedule: Monday- Friday 8am-5pm PST

If you are located in the Clark County Nevada, you will have the flexibility to telecommute* as you take on some tough challenges.

25% of expected travel within Clark County.

Primary Responsibilities:

• Uses pertinent data and facts and applies the information using the plan do study act (PDSA) model to solve a range of problems within area of expertise
• Investigates non-standard requests and problems, with some assistance from others
• Apply the quality quadruple aim methodology to strategies for continuous quality improvement. Prioritizes and organizes own work to meet deadlines
• Conduct barrier analysis using quality improvement tools to identify root causes and inform the development of data-driven targeted interventions or process enhancements.
• Provides explanations and information to others on topics within area of expertise
• Build collaborative relationships and ongoing communication with internal/external customers to facilitate quality improvement projects and improve outcomes.
• Provide written or verbal explanations for findings/recommendations using fact-based reasoning evidence
• Deliver training on clinical topics/trends/processes to various audiences
• Respond to questions/challenges regarding findings/recommendations
• Prepare and manage Excel-based datasets daily to support vendor programs, regulatory reporting, meetings, and project needs.
• Provide accurate and timely accounting, payment processing and financial reconciliation for both provider and customer programs.
• Ensure compliance with internal policies and external regulations, maintain detailed records.
• Supports advanced payment models driving quality performance.
• Assists in the innovation, collaboration, and development of health literacy marketing materials.

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:

• Undergraduate degree or 3+ years of equivalent work experience in data analytics in a healthcare setting
• 2+ years of experience in healthcare quality improvement or recent graduate with relevant coursework in one of the following areas: Introduction to Public Health, Healthcare Systems & Policy, Health Informatics, Database Management (SQL), Excel for Data Analysis, Health Data Visualization (e.g., Tableau, Power BI), Clinical Workflow & Operations
• 2+ years of experience with HEDIS reporting and requirements
• 1+ years of internship experience in healthcare quality, data analysis or system improvement in a managed care setting
• Intermediate level of proficiency with Microsoft Word, PowerPoint and Excel
• Reside in the Clark County, NV area and willing to spend up to 25% of your time in the local market
• Access to reliable transportation & valid US driver's license

Preferred Qualifications:

• Master's Degree
• Knowledge of CMS regulations and QAPI standards
• Strong written and verbal communication skills
• Knowledge with value-based contracting
• Accounting, payments, and processing experience
• Knowledge of health literacy marketing
• Strong organizational skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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