Clinical Quality Consultant - Kansas - Remote

UnitedHealth Group - Shawnee, KS

Full-time

Remote - Shawnee, KS

Insurance Carriers and Related Activities

About the position

The Clinical Quality Consultant (CQC) at UnitedHealth Group is responsible for driving clinical relationships and engagement with various stakeholders, including account management, quality registered nurses, physician practices, members, and pharmacies. The role focuses on improving health outcomes, quality, and practice performance while reducing medical costs. The CQC will analyze data, facilitate education, and develop provider-specific plans to enhance physician practice performance and reduce readmissions.

Responsibilities

• Provide analytical interpretation of HEDIS, Stars, Pharmacy, CAHPS and HOS reporting, and supplemental data submissions.
• Participate in business review meetings related to STAR activities, summarizing provider group performance and market performance.
• Evaluate provider group/provider office structure and operations to improve STAR measures.
• Perform chart review and data abstraction.
• Maintain effective communication and relationships with assigned provider groups and account managers.

Requirements

• 1+ years Healthcare/Health Plan/HEDIS/STARS experience and/or knowledge.
• Experience in medical record review.
• Experience with decision-making and exposure to 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 in a dynamic, fast-paced environment.
• Proven ability to focus 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 with various stakeholders.
• Proven solid problem-solving skills and ability to analyze problems.

Benefits

• Flexible remote work options for employees located in Kansas.