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The Clinical Quality Consultant (CQC) drive clinical relationships and engagement with account management, quality registered nurses, physician practices, members, and pharmacies while partnering internally (with areas such as Network contract ACO managers, Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with a goal of improving health, well-being, quality, and practice performance while reducing medical costs. Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closure, coding accuracy, facilitating effective education, and reporting, effective super utilizer engagement (e.g., members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities using data analytics, technology, workflow changes and clinical support. These roles develop comprehensive, provider-specific plans to increase their physician practice performance, reduce readmissions and improve their outcomes.

You’ll enjoy the flexibility to work remotely as long as you reside in the state of Ohio

Primary Responsibilities:

• Provide analytical interpretation of HEDIS, Stars, Pharmacy, CAHPS and HOS reporting, supplemental data submissions, EMR sweep reporting, Vendor performance reporting, Lab Data Pulls, including executive summaries to account management and provider groups

• Participate 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 Local leadership

• Evaluate provider group/provider office structure and characteristics, operations, and personnel to identify the most effective approaches and strategies in improving STAR measures

• Perform chart review and data abstraction

• Maintain effective and ongoing communications and relationship with assigned provider groups and account managers

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 1+ years Healthcare/Health Plan/HEDIS/STARS experience and/or knowledge

• Experienced in medical record review

• Demonstrated experience with decision-making., Experience should include in-depth, hands-on exposure in dealing with multiple constituents and customers

• Knowledge of managed care requirements related to clinical quality and provider relations

• Knowledge and application of continuous quality improvement concepts e.g., PDSA

• Basic knowledge of Microsoft Office applications, including Word, Excel, and Outlook

• Demonstrated success working in dynamic, fast-paced environment

• Proven ability to assist with focusing activities on a strategic direction to achieve targets

• Proven excellent time management and prioritization skills

• Proven excellent verbal and written communication skills

• Proven solid relationship building skills; ability to interact with providers, medical staff, peers, and internal company staff at all levels

• Proven solid problem-solving skills and ability to analyze problems, draw relevant conclusions, develop, and implement appropriate plan of action

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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