Senior Clinical Quality Analyst - Remote

UnitedHealth Group•Orlando, FL

3d•$72,800 - $130,000•Remote

About The Position

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together. Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs related to CMS Stars, HEDIS Measures and CAHPS/HOS. Conducts clinical quality data and reporting analysis with professional slide deck presentation of information. Responsible for the reporting and analysis of member care quality and for the development of plans, projects, and programs to support continuous quality improvement using HEDIS and other tools. If you are able to work on Eastern Time, You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

2+ years managed care experience
Experience working with regulatory requirements and accreditation standards (HEDIS, NCQA, JCAHO)
Experience in reporting, data analysis, and data management
Knowledge of managed care requirements related to clinical quality
Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
Advanced / Expert level of Excel and Power Point
Ability to work standard business hours in EST zone
Ability to travel up to 10%
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Tableau or similar data base and reporting experience
Experience creating reports related to quality improvement/performance outcomes
Proven ability to deal with ambiguity and drive results
Proven desire to make an impact, manage multiple tasks, and shift priorities quickly
Proven solid interpersonal skills and the ability to influence others
Proven solid communication skills, written and verbal
Proven leadership skills and results oriented

Responsibilities

Assesses and interprets customer needs and requirements
Identifies solutions to nonstandard requests and problems
Solves moderately complex problems and/or conducts moderately complex analyses
Summarizes actionable information in slide decks at appropriate level of communication
Works with minimal guidance; seeks guidance on only the most complex tasks
Translates concepts into practice
Provides explanations and information to others on difficult issues
Coaches, provides feedback, and guides others
Acts as a resource for others with less experience
Collect Quality data and/or information based on applicable standards, state/federal or other regulations, customer, or consumer requests, internal requests, or project assignments
Identify appropriate sources for data or information either internally or externally and collect data/information
Develop effective methods for data/information collection
Identify appropriate data platform or application (e.g., data bases, Intranet source, Internet source, Microsoft Excel, Smartsheet) and utilize to collect data or information
Investigate Quality problems identified and collect additional information to close gaps
Work cross functionally and coordinate with others internally or externally to gather information; overcome challenges to obtaining needed information
Evaluate data and/or information to identify inconsistencies, trends, other information needed, etc. (e.g., develop and/or run data queries, data comparisons across sources)
Analyze and interpret data or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant and/or are accurate and complete
Provide explanations or updates when data/information (e.g., clinical, administrative) are not accurate or unclear
Explain the characteristics of the data/information (e.g., clinical, administrative) including any unique attributes
Identify Quality improvement or intervention opportunities and work cross-functionally to develop interventions or recommendations presented in a summarized format
Develop or update work plans (e.g., annual work plan)
Develop or update program descriptions (e.g., annual program descriptions)
Develop program evaluations (e.g., annual program evaluation)
Develop, update, and/or review policies and procedures
Review results, conduct analyses (e.g., evaluate against goals/effectiveness of interventions over time), and prepare reports on findings with summarized recommendations
Follow regulations and internal or external protocols for communicating information or data
Utilize computer systems to identify and annotate information
Load completed information into relevant systems according to specifications
Develop an understanding of the intended audience and determine the best method to communicate data or information
Communicate Quality data or information in writing or verbally
Report results (e.g., quality improvement initiatives) to committees, Board of Directors, external stakeholders, regulatory agencies, etc. and respond to questions or solicit feedback and input
Develop understanding of customer requirements and/or expectations and anticipate needs to determine appropriate course of action
Develop audit or review processes (e.g., automated/technically driven)
Review relevant agreements (e.g., contractual, intersegment) and obtain clarification as necessary
Read and interpret standards/requirements and/or technical specifications (e.g., structure and process, CMS star ratings, , URAC, NCQA/HEDIS/ CAHPS/member satisfaction specifications, SNP)
Evaluate current processes, compare to relevant standards or specifications, and identify gaps in compliance or performance
Perform/participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)
Work cross functionally, making recommendations or clarifying information to assist in closing gaps that are identified or meeting customer expectations
Work with auditors or key stakeholders for review/approval of results
Develop and/or assist with corrective action plans based on audit findings or customer feedback
Review processes and performance against customer expectations to provide needed information or service
Define project scope and develop project plan
Identify and recruit appropriate staff to assist with projects as necessary
Coordinate with others to set appropriate deadlines when necessary
Collaborate with stakeholders for review, input, and/or approval at key milestones
Manage key relationships (e.g., vendors, stakeholders, regulatory bodies) to ensure milestones are achieved and performance objectives are met
Manage or actively participate in meetings (e.g., schedule, present, document meeting results, facilitate)
Provide information and feedback to project team with respect to achievement of objectives
Leverage clinical expertise to inform decision making and program development
Track timeframes/deadlines and collect data or information within required timeframes
Identify, prioritize, and proactively communicate potential barriers or risks to key stakeholders
Educate, motivate, and/or influence others (e.g., leadership, other stakeholders, including those for whom there is no direct line of authority) to understand the overall scope, overcome potential barriers, and engage in and commit to the process
Communicate and explain applicable standards (e.g., industry/performance) and/or technical specifications and identified gaps and/or changes in applicable standards
Develop educational materials (e.g., cross functional staff materials)
Work with others to ensure messaging to cross functional staff is appropriate to the audience, complete/accurate, and compliant (e.g., with external/internal regulations and protocols)
Train others on relevant policies, rules, or regulations (e.g., appropriate release of data, handling protected health information)
Serve as a resource providing explanations and expertise (e.g., providing information to others, satisfaction survey, vendors)