Clinical Quality Analyst
hace 3 semanas
Improve healthcare outcomes and quality by driving clinical relationships and engagement with account management, quality registered nurses, physician practices, members, and pharmacies.
Key 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 relationships with assigned provider groups and account managers.
Required Qualifications:
1+ years Healthcare/Health Plan/HEDIS/STARS experience and/or knowledge.
Experienced in medical record review.
Demonstrated experience with decision-making, including in-depth, hands-on exposure in dealing with multiple constituents and customers.
Knowledge of managed care requirements related to clinical quality and provider relations.
Knowledge and application of continuous quality improvement concepts, e.g., PDSA.
Basic knowledge of Microsoft Office applications, including Word, Excel, and Outlook.
Demonstrated success working in dynamic, fast-paced environments.
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 plans of action.
At UnitedHealth Group:
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.
Equal Employment Opportunity/Affirmative Action:
OptumCare 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.
Drug-Free Workplace:
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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