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Sr. Clinical Quality Specialist - Telecommute Warwick, RI job at UnitedHealth Group, Los Angeles

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UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The  Sr. Clinical Quality Specialist will be responsible for end-to-end Continuous Quality Improvement (CQI) process activities within UnitedHealthcare Community & State. Working on monitoring priority quality and population health measures, risk identification, diagnose process issues, identify process improvement solutions and process improvement implementation.. This position will also support quality auditing, analysis, reporting and developing plans and programs. Continuous engagement and collaboration with HEDIS team members and health plan leadership is essential. This role involves approximately 10% travel within Warwick, RI. 

 Primary Responsibilities:

  • Continuous monitoring of priority quality and population health measures for trends
  • Leading quality measure workgroups
  • Leading member and provider outreach interventions
  • Submitting, monitoring and analyzing data requests to drill down and find root causes/ outliers/ opportunity for improvement in quality measures
  • Ad hoc reporting
  • Uses pertinent data and facts to identify and solve a range of problems within area of focus or expertise
  • Extracting, trending and reporting data
  • Solves moderately complex problems and/or conducts moderately complex analyses
  • Works with some guidance; seeks guidance on only the most complex tasks
  • Acts as a resource for other HEDIS Quality Analysts with less experience
  • Be proficient in understanding of basic process management and total quality management principles and methodologies (e.g., Six Sigma; Model for Improvement. Lean)
  • Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and / or business priorities in order to build effective solutions
  • Some proficiency in understanding of upstream and downstream impacts to partners of business process operations and solutions
  • Engage and often directly support Quality auditing activities to validate process performance
  • Support the analysis of quality auditing findings as it relates to business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
  • Support engagement with relevant stakeholders (e.g., end users; SMEs; sponsors) to establish appropriate criteria and goals (e.g., efficiency; effectiveness) in order to direct investigation into problems and potential solutions
  • Support the estimation and / or quantify potential benefits, costs, and resource requirements associated with recommended business process solutions
  • Support the communication of potential impacts and risks associated with implementing proposed solutions, progress of actions taken to resolve risks and gaps identified
  • Additional activities that may apply 

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: 

  • Undergraduate degree or equivalent experience (in healthcare data analytics, quality)
  • 3+ years in a role supporting a quality function or related operational function
  • 3+ years of experience extracting, trending and reporting data
  • Commitment to get Certified Professional in Healthcare Quality (CPHQ) Certification within the first 24 months of hire
  • Intermediate experience with MS Office including Word, Excel and PowerPoint
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications: 

  • 3+ years of project management experience
  • HEDIS / NCQA Accreditation/ Medicare / STARS experience
  • Certified Professional in Healthcare Quality (CPHQ) Certification
  • Formal Quality Training experience (i.e., Six Sigma, Model for Improvement, Lean, , etc.)
  • Experience with utilizing and comparing past data trends and investigating data nuances - including CPT coding
  • Experience specifically working in a healthcare environment
  • Intermediate SharePoint experience

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.      

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


Job country: United States

City: Los Angeles

Category: Clinical Data Managers

Location: Los Angeles, CA, United States

Job posted 2022-06-04

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