Clinical Quality Specialist
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
UnitedHealthcare's Quality Management Performance is an integrated team serving all UnitedHealthcare businesses, focused on improving the health of our members, enhancing our operational effectiveness, reinforcing brand and reputation for high-quality health plans and helping members lives healthier lives.
Quality Management Performance combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve.
In addition to supporting UnitedHealthcare as a whole, this position focuses on HEDIS and clinical quality improvement for our Medicare programs and members. In this role, you will share in the responsibilities of supporting and driving change through reporting and analysis of quality metrics, as well as the development of programs to support continuous quality improvement using HEDIS and other tools.
In addition to working with the Quality Management Performance HEDIS staff, this position will collaborate and work closely with other key areas of quality including National and Regional Accreditation teams, CAHPS teams, CMS/SNP teams and others. This position will also work with external partners to ensure optimal HEDIS performance, including data collection vendors and auditors.
This position reports to the Regional Clinical Quality HEDIS Manager.
Responsibilities:
- Assist with the implementation of the National HEDIS improvement plan, including the HEDIS data collection and clinical improvement projects
- Participate in determination of annual HEDIS strategy as well as other clinical improvements
- Collaborate with the HEDIS Project Managers in the collection of RFI, ROADMAP and HOQ information for HEDIS
- Participate on Regional Quality Team to identify and implement region and or state-specific projects to improve HEDIS scores and CMS Star Ratings
- Collaborate with internal UnitedHealth Group partners such as the Clinical Advancement Team and Sister organizations OptumDM and OptumRx to promote clinical quality improvement across all Medicare plans
- Participate in regional quality programs and committees as needed
- Identify opportunities and actively participate in process improvements related to enhancing health plan quality
- Assist in developing targeted educational reminders for clinical/preventive initiatives
- Other responsibilities as assigned
Join the Quality Management Performance Team and live Our United Culture everyday! Integrity, Compassion, Relationships, Innovation and Performance.
Required:
- BS/BA degree in Nursing, Business, Public Health, Healthcare Administration or related field or applicable experience in the healthcare quality field.
- Minimum of 2 years Healthcare/Health Plan experience
- HEDIS experience and knowledge
- Strong 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
- Excellent team development skills
- Strong interpersonal skills
- Excellent time management and prioritization skills
- Excellent written and verbal communications skills
- Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint
Additional Assets Preferred:
- Minimum of 2 years HEDIS experience to include managing, planning and implementation
- Significant Clinical and/or Health Education background (RN or LPN desired)
- Experienced in medical record review desired
- Knowledge of MedAssurant's HEDIS application preferred
- Proficiency with Microsoft Access preferred
- SAS and SQL experience desired
- Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma or PDSA desired
