Clinical Quality Analyst, EPSDT Coordinator – Remote in NM

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.  

The Clinical Quality Analyst/EPSDT Coordinator is responsible for coordination of pediatric disease management and wellness programs aimed towards clinical quality improvement by working with the providers and the Health Plan staff to develop clinically oriented and community-based partnerships to improve health outcomes and increase quality scores based on state-specific quality measures. This position works closely with the Population Health Director to coordinate an interdisciplinary approach with providers and members to increase member adherence to identify preventive and chronic condition screenings and tests.  In this role, the EPSDT Coordinator will assist the Quality and Population Health Directors with the development of member-facing programs including potential member outreach education in the form of telephone, mailings, and potential coordination of clinic days with the quality team upon request. The goal of the Population Health team is population data assessment and disease management utilizing the continuous quality improvement approach and using approved clinical practice and disease management guidelines. The EPSDT Coordinator reports to the Population Health Director of the Health Plan.

This is a hybrid, with a home-based office with limited field-based work.

If you live in or within commutable driving distance to Albuquerque, NM and/ or Las Cruces, NM, you will have the flexibility to work remotely* as you take on some tough challenges.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
 

Required Qualifications:

• LISW, MSW, LPCC, BSN, case worker or RN with pediatric or related clinical experience in with active, unrestricted license in the state of New Mexico
• 3+ years of service delivery system or managed care setting experience
• 2+ years of population health or relevant pediatric chronic disease management medically fragile or developmentally disabled pediatric experience
• 1+ years of data analytics experience
• Experience working in Medicaid in the Managed Care setting
• Working knowledge and experience of EPSDT and the requirements for EPSDT
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
• Demonstrated ability to present to provider and Care Coordination and caregiver groups
• Driver’s license and access to reliable transportation
• Valid driver’s license, access to reliable transportation and the ability to travel locally to provider offices up to 75% of the time
• Reside in New Mexico
   

Preferred Qualifications:

• Pediatric program management or pediatric nursing experience with special populations experience, preferable both inpatient and outpatient settings
• Health care and insurance industry experience, including regulatory and compliance
• Experience with pediatric wellness and disease quality metrics
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
• Demonstrated ability to present data and create Power Point Presentations around quality metrics to providers and other groups  both within and outside the Health Plan
• Reside in Albuquerque or Las Cruces, NM areas

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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