Quality Performance Specialist

UnitedHealth Group•Irvine, CA

11h•$24 - $43•Hybrid

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Quality Performance Specialist is responsible to create and implement data-driven strategies and workplans that improve the health, well-being, and quality of care and service received by our Medi-Cal members, as demonstrated by high quality measure performance. This role will collaborate with internal and external key stakeholders, regional operations, IPA practices, FQHCs, and other community partners, to drive clinical relationships and engagements between members and their care delivery system. This focus of this role is Medi-Cal quality metric performance, which may include but is not limited to HEDIS and CMS Measure gap closure, and CAHPS/HOS patient experience performance. The ideal candidate will be: Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, in order to drive execution of PI strategies Accountable for improvement on HEDIS and STARs gap closure, improved patient experience and optimized patient outcomes Skilled at utilizing data to drive decisions, and has a passion for applying technology to achieve systematic solutions Passionate about continuous improvement, streamlined processes and workflow optimization Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a team-oriented atmosphere This position follows a hybrid schedule with three in-office days per week.

Requirements

2+ years of working with programs in HEDIS Quality, Stars, CAHPS/HOS experience
Experience with managed healthcare / care delivery business operations
Experience working directly with clinicians, provider practices and/or care delivery networks
Proven intermediate MS Office skills
Proven PowerPoint Presentation skills
Proven excellent communication skills
Valid CA Driver's license, current insurance and reliable transportation to local provider offices

Nice To Haves

Provider office administrative or call center experience
Experience with Technology-based Solutions (EHRs, IVR, Texting Applications, etc)
CLL (Common Language of Leadership) Values Based Competencies
Achievement Drive
Sets ambitious stretch goals
Shows initiative
Attacks tasks with energy and confidence
Motivates others with infectious enthusiasm
Deploys self against goals and objectives
Critical Thinking
Collects essential and relevant information
Assesses value and connectedness
Synthesizes information
Applies multiple analytical tools
Generates conclusions and probable best solutions
Runs scenarios
Leveraging Innovation
Anticipates opportunities
Generates and collects ideas
Synthesizes and combines ideas
Translates ideas into products/services
Creates an innovative friendly culture
Supports all innovation
Personal Impact Management
Assesses their personal impact against requirements
Develops a style aligned to culture
Manages their leadership shadow
Gets feedback on personal impact and effectiveness
Systems Thinking
Sees the bigger picture of how systems operate interdependently
Becomes a student of how complex systems work
Manages enterprise wide alignment of organizational systems
Utilizes the right system levers for change and organizational stability
Task & Project Management
Defines goals and outcomes
Aligns and deploys people, resources, tasks, and timelines
Uses on-going measurement and adjustment process
Provides on-time feedback and guidance

Responsibilities

Supports quality performance measures (e.g., HEDIS, CMS, CAHPS) by engaging targeted provider practices and collaborating on improvement workplans
Ensures work plans are successfully executed in a timely manner
Supports data reconciliation between contracted Medi-Cal healthplan and Optum internal quality reporting
Facilitates custom quality reports utilizing internal quality reporting resources
Ensures quality reporting alignment across Optum quality reporting tools and dashboards
Provides programmatic support to FQHC and other strategic community programs and projects
Supports programs integrating in-office embedded and wrap-around support including but not limited to patient scheduling, chart reviews, targeted mailings and IVR campaigns, workflow optimization and visible performance tracking
Provides new office staff/ new and refresher quality overview trainings
Facilitates Cozeva trainings and of best practice workflow implementation; promotes and supports EHR-Cozeva integration opportunities
Collaborates and aligns strategies with other regional support teams (e.g., Provider Relations and Population Health)
Maintains performance tracking related to assigned projects to ensure timely and accurate execution and required documentation; uses performance reports to track and trend progress
Participates in required meetings related to Medi-Cal Pay for Value (P4V) performance, measure updates, etc.
Stays informed on all member outreach activities and communication schedules, and shares updates to assigned practices
Supports continuous performance improvement through research and testing of new initiatives to assess success and scalability
Provides continuous feedback to manager and team on performance, barriers, opportunities, and action plans for all assigned practices
Other duties as assigned