Senior Clinical Quality Analyst - Remote

UnitedHealth Group•San Diego, CA

2d•$72,800 - $130,000•Remote

About The Position

Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You will also review medical records and interface with clinicians to ensure that treatment being rendered is within the community standard of care and identify areas where care can be improved. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. We're looking for a self-motivated licensed behavioral healthcare professional with Quality Improvement (QI), accreditation and / or data analysis experience. In this position, you would analyze essential data and develop and implement QI initiatives. The Quality Improvement team is focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high - quality health plans. Join us and help guide our efforts to improve the patient experience and satisfy our health plan customers. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. You’ll enjoy the flexibility to work remotely from California

Requirements

Current, unrestricted California behavioral health license (e.g., LMFT, LCSW, LPCC, Psychologist, or other independently licensed behavioral health clinician, as applicable)
Current California residency
3+ years of professional experience in behavioral health, clinical quality, quality management, utilization management, case management, or a related healthcare function
1+ years of experience in a managed care, health plan, delegated entity, or behavioral health quality environment
Experience using Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint, with the ability to create, edit, and present reports and documents
Access to reliable high-speed internet and a home workspace suitable for remote work

Nice To Haves

Experience collecting, analyzing, and presenting clinical or quality performance data
Experience supporting performance improvement projects or using data to inform intervention strategies and operational improvements
Experience preparing audit materials, annual evaluations, committee documentation, or accreditation evidence
Working knowledge of California behavioral health regulatory and accreditation requirements, including DMHC, NCQA, HEDIS, and URAC standards
Proven solid written and verbal communication skills, including experience presenting findings and recommendations to customers or leadership
Demonstrated ability to manage multiple priorities independently in a highly collaborative environment

Responsibilities

Support behavioral health quality improvement activities, performance improvement projects, and annual program deliverables for California health plan customers
Collect, analyze, and interpret clinical and operational data to identify trends, risks, and opportunities for improvement in quality performance and member experience
Prepare reports, summaries, dashboards, and presentation materials for internal leadership, committees, and external customers
Partner with health plan customers and internal stakeholders to monitor quality metrics, support corrective actions, and advance behavioral health quality initiatives
Support compliance with California and national quality requirements, including applicable state and federal regulations and accreditation standards such as DMHC, NCQA, HEDIS, and URAC
Conduct quality of care reviews and investigations related to enrollee grievances, identified quality concerns, and sentinel events, and document findings in accordance with established processes
Assist in preparing audit-ready documentation and evidence for quality management reviews, audits, and accreditation activities
Support quality management committees and workgroups through agenda development, meeting materials, follow-up tracking, and documentation of key actions
Review clinical documentation and collaborate with licensed clinicians and operations partners to promote compliance with documentation standards and community standards of care
Contribute to behavioral health HEDIS and related performance improvement efforts by helping design, implement, and monitor interventions in partnership with customers and cross-functional teams