Clinical Quality Advisor I
2 weeks ago
At UnitedHealth Group, we are dedicated to transforming the landscape of health care. Our mission is to provide comprehensive health programs that span the entire continuum of care. Join us in our commitment to Caring. Connecting. Growing together.
The Clinical Quality Consultant I plays a pivotal role in ensuring uniformity, streamlining processes, and disseminating best practices in collaboration with healthcare providers. This position is instrumental in achieving a minimum 4 STAR rating through active participation in quality enhancement initiatives, formulating recommendations for quality improvement plans, and developing tools and databases to capture essential data across various regions. The CQCI will work closely with Senior Quality Consultants in each regional market and engage with the Corporate Quality team on enterprise-wide initiatives.
Key Responsibilities:
- Craft market-specific business strategies to encourage providers to enhance STAR measures to achieve a rating of 4 STARS or above.
- Deliver analytical insights on STAR and HEDIS reporting, including executive summaries for planning and provider groups.
- Serve as the primary contact for all STAR-related activities within assigned markets, collaborating with Quality corporate operations and Regional/Market operations.
- Engage in regular business review meetings to assess provider group performance and market outcomes as required by leadership.
- Analyze provider group structures and operations to identify effective strategies for improvement.
- Tailor communications and initiatives to support practice success.
Required Qualifications:
- Minimum of 1 year of experience in Healthcare or Health Plans.
- At least 1 year of experience or knowledge in HEDIS.
- Proven experience in influencing behavioral changes.
- Experience in managed care, particularly in 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 a keen attention to detail.
- Experience in Clinical and/or Health Education.
- Familiarity with 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 interact effectively with medical staff, peers, and internal teams at all levels.
- Skilled in resolving process challenges across multiple functional areas.
- Strong analytical and problem-solving skills.
- Good business acumen, particularly in relation to Medicare.
- 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 follow verbal and written instructions.
- Logical reasoning skills for problem-solving.
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