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The Clinical Quality Consultant I will drive consistency, efficient processes and share best practices – in a collaborative effort with the providers – designed to facilitate a minimum 4 STAR rating. The CQCI will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with the Senior Quality Consultants for each regional/market. This role will also work collaboratively with the Corporate Quality team on enterprise initiatives and activities in a matrix relationship.

If you are located in Golden, CO, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher

• Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups

• Be the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations.

• 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 Regional leadership.

• Review provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies

• Focus communications and efforts accordingly

• Develop solution-based, user-friendly initiatives to support practice success

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:

• 1+ years of experience with Healthcare/Health Plan

• 1+ years of HEDIS experience and/or knowledge

• Professional experience persuading changes in behavior

• Experience in managed care working with network and provider relations

• Solid knowledge of managed care requirements related to clinical quality

• Solid knowledge of the Medicare market, products and competitors

• Microsoft Office specialist with exceptional attention to detail

Preferred Qualifications:

• Clinical and/or Health Education experience

• Knowledge base of clinical standards of care, preventative health, and Star measures

• Solid communication and presentation skills

• Solid relationship building skills with clinical and non-clinical personnel

• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels

• Ability to solve process problems crossing multiple functional areas and business units

• Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

• Good business acumen, especially as it relates to Medicare

Physical & Mental Requirements:

• Ability to lift up to 10 pounds

• Ability to sit for extended periods of time

• Ability to stand for extended periods of time

• Ability to use fine motor skills to operate office equipment and/or machinery

• Ability to properly drive and operate a vehicle

• Ability to receive and comprehend instructions verbally and/or in writing

• Ability to use logical reasoning for simple and complex problem solving

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado Residents Only: The hourly range for Colorado residents is $23.22 to $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At 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.