Clinical Quality Assurance Specialist
2 weeks ago
Join Our Mission: At UnitedHealth Group, we are dedicated to transforming healthcare. This is your chance to be part of a team that goes beyond traditional care, creating integrated health programs that span the entire continuum of care.
Role Overview: The Clinical Quality Consultant I will play a pivotal role in ensuring consistency and efficiency in processes while sharing best practices in collaboration with healthcare providers. The goal is to achieve a minimum 4 STAR rating.
Key Responsibilities:
- Develop strategic market plans to encourage providers to enhance their Stars measures to achieve 4 STARS or higher.
- Analyze Stars and HEDIS reporting, providing executive summaries to plan and provider groups.
- Act as the primary contact for all STARS-related activities within assigned markets, working closely with Quality corporate operations and Regional/Market operations.
- Engage in regular business review meetings to summarize provider group and market performance related to STAR activities.
- Evaluate provider group structures and operations to identify effective strategies for improvement.
- Create user-friendly initiatives aimed at supporting practice success.
Qualifications:
- Minimum of 1 year of experience in Healthcare or Health Plan.
- Experience or knowledge of HEDIS.
- Proven ability to influence behavioral changes.
- Experience in managed care with a focus on network and provider relations.
- Strong understanding of managed care requirements concerning clinical quality.
- Familiarity with the Medicare market, products, and competitors.
- Proficient in Microsoft Office with a keen 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 capabilities with both clinical and non-clinical personnel.
- Ability to engage effectively with medical staff and internal teams at all levels.
- Skilled in solving process-related issues across various functional areas.
- Strong analytical skills to assess problems and develop actionable plans.
Physical & Mental Requirements:
- Ability to lift up to 10 pounds.
- Capacity to sit or stand for extended periods.
- Proficient in using fine motor skills for office equipment.
- Ability to comprehend and follow verbal and written instructions.
- Logical reasoning skills for problem-solving.
Commitment to Diversity: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. We welcome all qualified applicants 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.
Workplace Environment: UnitedHealth Group maintains a drug-free workplace. Candidates are required to pass a drug test prior to employment.
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