Clinical Quality Consultant - Remote

Accreditation And Regulatory Related Clinical Quality Improvement

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Positions in this job family are responsible for performing accreditation and regulatory related clinical quality improvement functions. These roles lead the reporting and analysis of member care quality and develop, implement, and evaluate plans and programs that support continuous quality improvement. Responsibilities include leveraging data analytics and organization-approved AI tools to enhance analysis, reporting efficiency, and insight generation while ensuring alignment with regulatory, accreditation, privacy, and data security requirements.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provide strategic direction and subject matter expertise for clinical quality improvement, quality management, and accreditation programs
• Collaborate with internal partners and team members to identify opportunities for quality improvement, innovation, and application of accreditation best practices
• Lead and/or support accreditation survey submission processes, including coordination of evidence, narratives, timelines, and final submission to accrediting bodies (e.g., NCQA, URAC)
• Plan and participate in accreditation readiness assessments; serve as a technical advisor; review state or regional teamwork; and support ongoing compliance with accreditation standards (e.g., NCQA, URAC)
• Monitor, measure, and develop clinical effectiveness and performance reports required to maintain accreditation with nationally recognized accrediting organizations
• Interpret complex qualitative and quantitative data, applying critical thinking and AI supported analysis to identify trends, risks, and improvement opportunities
• Develop innovative, data driven solutions to complex quality, accreditation, and compliance challenges
• Prepare and present clear, comprehensive reports and analyses for diverse stakeholders, leveraging AI tools to support drafting, synthesis, and presentation development while ensuring accuracy and regulatory alignment
• Interface with accreditation agencies, regulatory bodies, and other compliance entities as required
• Serve as a key resource on complex or high risk issues and contribute to the development and dissemination of accreditation best practices
• Perform other duties as assigned

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:

• 3+ years of experience and solid knowledge of managed care and market regulatory requirements related to health plan quality
• 2+ years of solid, documented experience in successfully preparing and submitting URAC, NCQA or other healthcare accreditation surveys
• Solid knowledge of managed care requirements related to clinical quality and regulatory compliance
• Proficiency in Microsoft Office applications (Excel or Access, Word, and PowerPoint) and proficient use of Microsoft Copilot or other organization-approved AI tools
• Proven excellent time management and prioritization skills
• Proven excellent oral and written communication skills
• Proven solid interpersonal skills

Preferred Qualification:

• Background in Individual Family Plan (IFP)

Skills You Will Develop:

• Build strong relationships by establishing rapport quickly and connecting with others in an engaging, proactive, and productive manner
• Strengthen problem solving skills by clearly understanding issues, identifying root causes, developing effective solutions, and monitoring ongoing performance
• Develop resilience by adapting to change, persevering through challenges, and recovering quickly to stay focused on goals
• Develop effective use of AI-enabled tools (e.g., Copilot) to support analysis, problem-solving, and the development of clear, high-quality work products

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 $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group 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.

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