Clinical Quality Consultant - WI, KS, MO, IN, OH - Remote

Clinical Quality Consultant

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

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.

Position Details:

• Schedule: Monday - Friday, 8:00am - 5:00pm
• If you are located in Wisconsin, Kansas, Missouri, Indiana, or Ohio you will have the flexibility to work remotely* as you take on some tough challenges.

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 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
• 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
• Currently reside in the state of Wisconsin, Kansas, Missouri, Indiana, or Ohio

Preferred Qualifications:

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

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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