Clinical Quality Consultant - Wisconsin - Remote
About The Position
The Clinical Quality Consultant (CQC) drives clinical relationships and engagement with account management, quality registered nurses, physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO managers, Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with a goal of improving health, well-being, quality, and practice performance while reducing medical costs. Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closure, coding accuracy, facilitating effective education, and reporting, effective super utilizer engagement (e.g., members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities using data analytics, technology, workflow changes and clinical support. These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions and improve their outcomes.
Requirements
- 1+ years HEDIS/STARS experience and/or knowledge
- Experienced in medical record review
- Demonstrated experience with decision-making. Experience should include in-depth, hands-on exposure in dealing with multiple constituents and customers
- Basic knowledge of Microsoft Office applications, including Word, Excel, and Outlook
- Demonstrated success working in dynamic, fast-paced environment
- Proven ability to assist with focusing activities on a strategic direction to achieve targets
- Proven excellent time management and prioritization skills
- Proven excellent verbal and written communication skills
- Proven solid relationship building skills; ability to interact with providers, medical staff, peers, and internal company staff at all levels
- Proven solid problem-solving skills and ability to analyze problems, draw relevant conclusions, develop, and implement appropriate plan of action
Nice To Haves
- Knowledge of managed care requirements related to clinical quality and provider relations
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Responsibilities
- Provide analytical interpretation of HEDIS, Stars, Pharmacy, CAHPS and HOS reporting, supplemental data submissions, EMR sweep reporting, Vendor performance reporting, Lab Data Pulls, including executive summaries to account management and provider groups
- Participate in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities, which summarize provider group performance and market performance, as requested by, or required by Quality or Local leadership
- Evaluate provider group/provider office structure and characteristics, operations, and personnel to identify the most effective approaches and strategies in improving STAR measures
- Perform chart review and data abstraction
- Maintain effective and ongoing communications and relationship with assigned provider groups and account managers
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
