Clinical Quality Consultant

UnitedHealth Group•Newton, MA

4d•$91,700 - $163,700•Hybrid

About The Position

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. This position reports to the Senior Director of Quality in the Massachusetts Community Plan and plays a key role in advancing quality performance, health equity, and member outcomes. This position leads quality improvement initiatives, analyzes healthcare data, and partners across the organization to drive performance on HEDIS, Star Ratings, CAHPS, and state quality programs. Responsible for development, implementation, monitoring, and evaluation of quality improvement programs and interventions that support performance on state and federal quality measures, regulatory requirements, and organizational objectives. If you are located within a commutable distance to Newton, MA you will have the flexibility to work remotely as you take on some tough challenges. Must be able to work EST hours 8am until 5pm.

Requirements

5+ years of experience leading healthcare quality improvement initiatives
5+ years of experience with analyzing and interpreting healthcare data
5+ years of healthcare experience with managed care, health plans, provider organizations, or a related healthcare setting
Intermediate level of proficiency in Microsoft Office - Outlook, Word, Power Point, and Excel
Willing to commit to improving health outcomes and advancing health equity
Willing and able to commute to Newton, MA as needed

Nice To Haves

Certified Professional in HealthCare Quality (CPHQ)
Experience working in an outpatient clinical setting
5+ years of experience with HEDIS measures, NCQA, and CMS Star Ratings
Active RN license
Experience with Medicaid and/or Medicare managed care programs
Experience developing and implementing health equity programs and interventions
Strong analytical and critical thinking skills
Excellent written, verbal and presentation skills
Ability to work independently with minimal supervision
Ability to effectively manage multiple priorities and projects simultaneously
Ability to influence and collaborate within a highly matrixed organization.
Strong collaboration and relationship-building skills
Have limited distractions in the work environment

Responsibilities

Lead the development, implementation, evaluation, and reporting of the Massachusetts Community Plan’s Five-Year Health Equity Strategic Plan
Design, implement, and evaluate quality improvement strategies to improve performance on Medicare Star Ratings, HEDIS®, CAHPS®, and state-mandated quality measures
Develop understanding of customer requirements and/or expectations and anticipate needs to determine appropriate course of action
Interpret and apply regulatory, accreditation, and contractual requirements, including NCQA, CMS Star Ratings, HEDIS, CAHPS, and EOHHS standards
Collaborate across clinical, operational, provider, and corporate teams to drive quality initiatives, resolve issues, and achieve performance goals
Prepare and present quality performance results, strategic initiatives, and recommendations to leadership, state agencies, and other key stakeholders