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Senior Clinical Quality Improvement Specialist - Remote

Company: UnitedHealth Group
Location: Tallahassee
Posted on: September 15, 2023

Job Description:

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 and help people live healthier lives while doing -your life's best -work.(sm) -Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member - centric approach to care. As a Senior Quality Specialist, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements and HEDIS improvements. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives. We're looking for a self - motivated behavioral healthcare professional with Quality Improvement (QI), accreditation and / or data analysis experience. In this position, you would analyze essential data and develop and implement QI initiatives. The Quality Management (QM) team is focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high - quality health plans. Join us and help guide our efforts to improve the patient experience and satisfy our health plan customers. It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. -Primary Responsibilities:

  • Provide support to health plan customers by responding to customer requests, anticipating issues and problem solving
  • Develop and support quality improvement activities and performance improvement plans by:
    • Gathering and analyzing data
    • Preparing written reports and annual core documents for customers
    • Presenting analyses to customers and working collaboratively to improve the member experience
    • Assisting in developing department strategic action plans including identification of objectives, goals and strategies
    • Participate in designing, creating and implementing quality improvement projects and initiatives in support of the behavioral health HEDIS measures, working collaboratively with health plan customers when appropriate
    • Regularly meet with health plan customers to develop and present reports including data, analysis, activities and improvement initiatives
    • Support ongoing monitoring and compliance with QM Policies and Procedures and prepare documents appropriate to meet national and customer NCQA and URAC accreditation standards
    • Interface with key departments, as necessary in order to identify barriers, opportunities and intervention to improve performance
    • Assume responsibility for data integrity among various internal groups and/or between internal and external sources
    • Develop, analyze and monitor new, routine and ad hoc reports using multiple data sources and systems
    • Participate in preparation of materials and evidence necessary for audits related to QM
    • Assist with preparation and facilitation of QM Committees and workgroups
    • Actively participate in relevant department and essential QM Committee meetings and workgroups in order to implement QM Program
    • Conduct and manage outcomes of various studies that may include analyzing, reviewing, forecasting, trending and presenting information for quality management planning and management needs 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 behavioral healthcare experience -
      • 1+ years of experience working for a managed care organization
      • Proven intermediate computer skills (Microsoft Word, Excel and Outlook) with the ability to navigate a Windows environment. Create, edit, save and send documents utilizing Microsoft Office
      • Access to high-speed internet services along with space for home office set upPreferred Qualifications: - - - - - - - - -
        • Master's degree in behavioral health or related field
        • Behavioral health license - (ex. LPC, MSW, LCSW, LCPC )
        • CPHQ or other quality certification -
        • 1+ years of experience collecting, analyzing and presenting data
        • 2+ years of experience developing and implementing performance improvement projects, or using data to develop intervention strategies to improve outcomes
        • Knowledge and experience with national QI standards (NCQA, HEDIS, URAC)
        • Experience creating reports related to quality improvement / performance outcome
        • Proven presentation skills -(present reports to health plan customers)
        • Demonstrated ability to manage multiple projects simultaneously
        • Proven ability to work independently - -California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. -*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyAt 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.

Keywords: UnitedHealth Group, Tallahassee , Senior Clinical Quality Improvement Specialist - Remote, Healthcare , Tallahassee, Florida

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