Quality Assurance Specialist in Healthcare

2 weeks ago

Golden, Colorado, United States UnitedHealth Group Full time

For those aspiring to shape the future of healthcare, this is your chance. We are advancing beyond basic services to create health programs that are seamlessly integrated across the entire spectrum of care. Join us to embark on a journey of Caring. Connecting. Growing together.

The Clinical Quality Consultant I will be instrumental in promoting uniformity, optimizing processes, and disseminating best practices in collaboration with healthcare providers, aimed at achieving a minimum 4 STAR rating. The CQCI will engage in initiatives for quality enhancement, formulate recommendations for quality improvement strategies, and develop tools and databases to gather pertinent data for each region. This role will work closely with Senior Quality Consultants across various regions and markets, as well as with the Corporate Quality team on enterprise-wide initiatives in a matrixed environment.

Key Responsibilities:

  • Craft market-specific business strategies to encourage providers to enhance Stars measures to achieve 4 STARS or higher.
  • Deliver analytical insights on Stars and HEDIS reporting, including executive summaries for planning and provider groups.
  • Act 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 leadership.
  • Analyze provider group structures and operations to identify effective strategies and approaches.
  • Tailor communications and efforts accordingly.
  • Develop user-friendly, solution-oriented initiatives to support the success of practices.
You'll be recognized and rewarded for your contributions in an environment that challenges you and provides clear guidance on achieving success in your role, along with opportunities for professional development in other areas of interest.

Required Qualifications:
  • 1+ years of experience in Healthcare/Health Plans.
  • 1+ years of experience or knowledge in HEDIS.
  • 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.
  • Comprehensive 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 teams at all levels.
  • Capability to resolve process issues across multiple functional areas and business units.
  • Strong problem-solving skills, with the ability to analyze issues, draw relevant conclusions, 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 for operating office equipment.
  • Ability to drive and operate a vehicle.
  • Ability to comprehend instructions both verbally and in writing.
  • Ability to apply logical reasoning for problem-solving.

Diversity Commitment: At UnitedHealth Group, we are dedicated to creating a diverse and inclusive environment. We believe that everyone, regardless of race, gender, sexuality, age, location, or income, deserves the opportunity to lead a healthy life. We are committed to addressing health disparities and improving health outcomes for all.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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