EPSDT Clinical Quality Analyst - Remote in Arizona

UnitedHealth Group•Phoenix, AZ

18h•$29 - $52•Remote

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Are you passionate about improving health outcomes for children? Join us in transforming healthcare by supporting our Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) program initiatives. This is your opportunity to contribute to comprehensive health programs that ensure children receive the preventive services and treatments they need to thrive. As a Clinical Quality Analyst focusing on EPSDT, you will play a vital role in the strategy and implementation of clinical quality improvement initiatives. Your expertise will directly impact the health and well-being of children, guiding our efforts to meet regulatory standards and enhance service delivery. Working Schedule: Monday through Friday between the hours of 8 am to 5 pm. Fulltime telecommute position with home-based office. Must be able to attend onsite meetings, when needed up to 10%25 of the time. If you are located in Arizona, you will have the flexibility to work remotely as you take on some tough challenges

Requirements

2+ years of project management or quality improvement experience, preferably in a Medicaid or Medicare environment
2+ years of experience with data manipulation and reporting software (Microsoft Excel, Access, etc.) to prepare analytical reports
2+ years of experience with verbal and written communication to support effective collaboration with internal teams and external partners
Reside in Arizona and be able to travel to the local office up to 10%25 of the time based on business needs

Nice To Haves

Experience with EPSDT and/or quality improvement initiatives related to pediatric care
Familiarity with Snowflake environments or a willingness to learn
Medicaid/Medicare experience
Proven ability to solve complex problems and enhance program effectiveness

Responsibilities

EPSDT Program Monitoring and Compliance:
Monitor performance on EPSDT requirements including well child visits, developmental screenings, oral health, immunizations, vision/hearing screenings, lead testing, and other mandated periodicity schedule components
Review claims, encounters, and supplemental data to evaluate compliance with AHCCCS EPSDT standards
Track key EPSDT indicators (preventive visit timeliness, screenings completed, overdue services) and identify emerging trends, barriers, and improvement opportunities
Ensure program adherence to AHCCCS Medical Policy Manual (AMPM Policy 430) EPSDT requirements, including required periodicity schedules, and reporting expectations
Support EPSDT program workflow design
Identify process inefficiencies and recommend improvements
Oversee projects aimed at increasing member utilization of EPSDT services, ensuring children receive necessary screenings and interventions
Quality Improvement Activities: Assist Quality Manager/QM Director in implementing quality improvement activities specific to EPSDT, contributing to the health plan’s compliance with state and federal regulations
Regulatory Compliance: Support timely submission of regulator required or internal EPSDT reports and adherence to state EPSDT reporting requirements
Audit Support: Assist with provider audits which may include but are not limited to dental chart and fluoride varnish audits to ensure compliance with EPSDT protocols
Maintain EPSDT program supporting documentation including Standard Operating Procedures
AzEIP Coordination Support: Collaborate with UHC EPSDT Coordinator to coordinate actions related to the Arizona Early Intervention Program, providing essential support and services for children with developmental delays or disabilities
Assist with Member and Provider outreach as assigned, based on department needs
Other activities as assigned, based on department needs