Clinical Quality Consultant II

4 weeks ago

San Angelo, Texas, United States UnitedHealth Group Full time

Unlock Your Potential in Healthcare Quality Improvement

At UnitedHealth Group, we're committed to helping people live healthier lives and making the healthcare system work better for everyone. As a Clinical Quality Consultant II, you'll play a vital role in driving consistency, efficient processes, and sharing best practices with healthcare providers to achieve a minimum 4 STAR performance.

This is a field-based, hybrid position that requires collaboration with regional/market teams and leadership in a matrix relationship. You'll participate in quality improvement initiatives, attend monthly or joint operating committee meetings, develop recommendations for quality remediation plans, and create tools and databases to capture relevant data for each region.

Key Responsibilities:

  • Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
  • Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
  • Be the primary go-to person for all STARS-related activities within your assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations.
  • Lead or participate and present in weekly, monthly, bi-monthly, quarterly, and/or annual business review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership.
  • Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
  • Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes
  • Focus communications and efforts accordingly
  • Develop solution-based, user-friendly initiatives to support practice success
  • Perform all other related duties as assigned

Requirements:

  • 2+ years of Healthcare/Health Plan experience
  • 2+ years of HEDIS experience and/or knowledge
  • Solid data management and/or project management skills
  • Solid knowledge of managed care requirements related to clinical quality
  • Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
  • Solid proficiency with Microsoft Office applications, including: Word, Excel, and PowerPoint

Preferred Qualifications:

  • Significant Clinical and/or Health Education experience
  • Experience working with HEDIS software vendors (management, building relationships, issue resolution, etc.)
  • Experienced in medical record review
  • Proficiency with Microsoft Windows Suite (PPT, Excel, Word, Visio)
  • Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma, Lean, and/or PDSA
  • Excellent team development skills
  • Solid interpersonal skills
  • Excellent time management and prioritization skills
  • Excellent written and verbal communications skills

Physical & Mental Requirements:

  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to properly drive and operate a vehicle
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem-solving

At UnitedHealth Group, we're committed to creating a diverse and inclusive environment that values and respects the unique experiences and perspectives of all employees. We believe that everyone deserves the opportunity to live their healthiest life, regardless of their background or circumstances.

UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.

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

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