Quality Performance Specialist

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The Quality Performance Specialist is responsible to create and implement data-driven strategies and workplans that improve the health, well-being, and quality of care and service received by our Medi-Cal members, as demonstrated by high quality measure performance.  This role will collaborate with internal and external key stakeholders, regional operations, IPA practices, FQHCs, and other community partners, to drive clinical relationships and engagements between members and their care delivery system. This focus of this role is Medi-Cal quality metric performance, which may include but is not limited to HEDIS and CMS Measure gap closure, and CAHPS/HOS patient experience performance.

The ideal candidate will be:

• Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, in order to drive execution of PI strategies
• Accountable for improvement on HEDIS and STARs gap closure, improved patient experience and optimized patient outcomes
• Skilled at utilizing data to drive decisions, and has a passion for applying technology to achieve systematic solutions
• Passionate about continuous improvement, streamlined processes and workflow optimization
• Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a team-oriented atmosphere

This position follows a hybrid schedule with three in-office days per week.

Primary Responsibilities:

Under the supervision of the VP, Government Programs and in collaboration with other stakeholders, the Quality Performance Specialist will implement data-driven strategies and workplans that improve the overall health and service provided to our Medi-Cal patients. The goals of the program may include:

• Supports quality performance measures (e.g., HEDIS, CMS, CAHPS) by engaging targeted provider practices and collaborating on improvement workplans
• Ensures work plans are successfully executed in a timely manner
• Supports data reconciliation between contracted Medi-Cal healthplan and Optum internal quality reporting
• Facilitates custom quality reports utilizing internal quality reporting resources
• Ensures quality reporting alignment across Optum quality reporting tools and dashboards
• Provides programmatic support to FQHC and other strategic community programs and projects
• Supports programs integrating in-office embedded and wrap-around support including but not limited to patient scheduling, chart reviews, targeted mailings and IVR campaigns, workflow optimization and visible performance tracking
• Provides new office staff/ new and refresher quality overview trainings
• Facilitates Cozeva trainings and of best practice workflow implementation; promotes and supports EHR-Cozeva integration opportunities
• Collaborates and aligns strategies with other regional support teams (e.g., Provider Relations and Population Health)
• Maintains performance tracking related to assigned projects to ensure timely and accurate execution and required documentation; uses performance reports to track and trend progress
• Participates in required meetings related to Medi-Cal Pay for Value (P4V) performance, measure updates, etc.
• Stays informed on all member outreach activities and communication schedules, and shares updates to assigned practices
• Supports continuous performance improvement through research and testing of new initiatives to assess success and scalability
• Provides continuous feedback to manager and team on performance, barriers, opportunities, and action plans for all assigned practices
• Other duties as assigned

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:

• 2+ years of working with programs in HEDIS Quality, Stars, CAHPS/HOS experience
• Experience with managed healthcare / care delivery business operations
• Experience working directly with clinicians, provider practices and/or care delivery networks
• Proven intermediate MS Office skills
• Proven PowerPoint Presentation skills
• Proven excellent communication skills
• Valid CA Driver's license, current insurance and reliable transportation to local provider offices

Preferred Qualifications:

• Provider office administrative or call center experience

• Experience with Technology-based Solutions (EHRs, IVR, Texting Applications, etc)

CLL (Common Language of Leadership) Values Based Competencies

• Achievement Drive
  • Sets ambitious stretch goals
  • Shows initiative
  • Attacks tasks with energy and confidence
  • Motivates others with infectious enthusiasm
  • Deploys self against goals and objectives
• Critical Thinking
  • Collects essential and relevant information
  • Assesses value and connectedness
  • Synthesizes information
  • Applies multiple analytical tools
  • Generates conclusions and probable best solutions
  • Runs scenarios
• Leveraging Innovation
  • Anticipates opportunities
  • Generates and collects ideas
  • Synthesizes and combines ideas
  • Translates ideas into products/services
  • Creates an innovative friendly culture
  • Supports all innovation
• Personal Impact Management
  • Assesses their personal impact against requirements
  • Develops a style aligned to culture
  • Manages their leadership shadow
  • Gets feedback on personal impact and effectiveness
• Systems Thinking
  • Sees the bigger picture of how systems operate interdependently
  • Becomes a student of how complex systems work
  • Manages enterprise wide alignment of organizational systems
  • Utilizes the right system levers for change and organizational stability
• Task & Project Management
  • Defines goals and outcomes
  • Aligns and deploys people, resources, tasks, and timelines
  • Uses on-going measurement and adjustment process
  • Provides on-time feedback and guidance

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 hourly pay for this role will range from $23.89 to $42.69 per hour 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.  

OptumCare  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.

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