Clinical Performance Consultant I

1 week ago

Golden, Colorado, United States UnitedHealth Group Full time

For those passionate about shaping the future of healthcare, this is your chance. We are advancing beyond standard care to implement health programs that are integrated throughout the entire care continuum. Join us to begin Caring. Connecting. Growing together.

The Clinical Quality Consultant I will ensure uniformity, streamline processes, and disseminate best practices in collaboration with healthcare providers, aimed at achieving a minimum 4 STAR rating. The CQCI will engage in quality enhancement initiatives, formulate recommendations for quality improvement plans, and develop tools and databases to gather pertinent data for each region. This position will work closely with Senior Quality Consultants across various regions and markets, as well as collaborate with the Corporate Quality team on enterprise-wide initiatives and activities within a matrix framework.

Key Responsibilities:

  • Craft market business strategies to encourage providers to enhance Stars measures to achieve 4 STARS or above.
  • Deliver analytical insights on Stars and HEDIS reporting, including executive summaries for planning and provider groups.
  • Serve as the primary contact for all STARS-related activities within assigned markets, collaborating with Quality corporate operations and Regional/Market operations.
  • Participate in various business review meetings related to STAR activities, summarizing provider group and market performance as required by Quality or Regional leadership.
  • Assess provider group structures and characteristics, as well as provider office operations and personnel, to identify the most effective strategies.
  • Focus communications and efforts accordingly.
  • Develop solution-oriented, user-friendly initiatives to support practice success.
You'll be recognized and rewarded for your contributions in an environment that will challenge you and provide clear guidance on what it takes to excel in your role, as well as opportunities for development in other areas of interest.

Required Qualifications:
  • 1+ years of experience in Healthcare/Health Plans.
  • 1+ years of HEDIS experience and/or knowledge.
  • Professional experience in influencing behavioral changes.
  • Experience in managed care with a focus on network and provider relations.
  • Strong understanding of managed care requirements related to clinical quality.
  • Solid knowledge of the Medicare market, products, and competitors.
  • Proficient in Microsoft Office with exceptional attention to detail.
Preferred Qualifications:
  • Experience in Clinical and/or Health Education.
  • Knowledge of clinical standards of care, preventive health, and Star measures.
  • Excellent communication and presentation skills.
  • Strong relationship-building skills with both clinical and non-clinical personnel.
  • Proven ability to engage with medical staff, peers, and internal company personnel at all levels.
  • Capability to resolve process issues across multiple functional areas and business units.
  • Strong problem-solving skills; ability to analyze issues, draw relevant conclusions, and devise and implement effective action plans.
  • Good business acumen, particularly in relation to Medicare.
Physical & Mental Requirements:
  • Ability to lift up to 10 pounds.
  • Ability to sit for extended periods.
  • Ability to stand for extended periods.
  • Ability to use fine motor skills to operate office equipment and/or machinery.
  • Ability to drive and operate a vehicle safely.
  • Ability to comprehend instructions both verbally and in writing.
  • Ability to apply logical reasoning for simple and complex problem-solving.
Diversity Commitment: At UnitedHealth Group, we are dedicated to helping individuals lead healthier lives and enhancing the health system for everyone. We believe that everyone, regardless of race, gender, sexuality, age, location, or income, deserves the opportunity to achieve their healthiest life. We are committed to addressing health disparities and improving health outcomes as part of our mission.

Equal Opportunity Employer: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Drug-Free Workplace: UnitedHealth Group maintains a drug-free workplace. Candidates are required to pass a drug test prior to commencing employment.

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