Clinical Quality Consultant

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. 

This position reports to the Senior Director of Quality in the Massachusetts Community Plan and plays a key role in advancing quality performance, health equity, and member outcomes. This position leads quality improvement initiatives, analyzes healthcare data, and partners across the organization to drive performance on HEDIS, Star Ratings, CAHPS, and state quality programs. Responsible for development, implementation, monitoring, and evaluation of quality improvement programs and interventions that support performance on state and federal quality measures, regulatory requirements, and organizational objectives.

If you are located within a commutable distance to Newton, MA you will have the flexibility to work remotely* as you take on some tough challenges. Must be able to work EST hours 8am until 5pm.

Primary Responsibilities:

• Lead the development, implementation, evaluation, and reporting of the Massachusetts Community Plan's Five-Year Health Equity Strategic Plan
• Design, implement, and evaluate quality improvement strategies to improve performance on Medicare Star Ratings, HEDIS®, CAHPS®, and state-mandated quality measures
• Develop understanding of customer requirements and/or expectations and anticipate needs to determine appropriate course of action
• Interpret and apply regulatory, accreditation, and contractual requirements, including NCQA, CMS Star Ratings, HEDIS, CAHPS, and EOHHS standards  
• Collaborate across clinical, operational, provider, and corporate teams to drive quality initiatives, resolve issues, and achieve performance goals
• Prepare and present quality performance results, strategic initiatives, and recommendations to leadership, state agencies, and other key stakeholders  

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:

• 5+ years of experience leading healthcare quality improvement initiatives
• 5+ years of experience with analyzing and interpreting healthcare data
• 5+ years of healthcare experience with managed care, health plans, provider organizations, or a related healthcare setting
• Intermediate level of proficiency in Microsoft Office - Outlook, Word, Power Point, and Excel
• Willing to commit to improving health outcomes and advancing health equity
• Willing and able to commute to Newton, MA as needed

Preferred Qualifications:

• Certified Professional in HealthCare Quality (CPHQ)
• Experience working in an outpatient clinical setting
• 5+ years of experience with HEDIS measures, NCQA, and CMS Star Ratings
• Active RN license
• Experience with Medicaid and/or Medicare managed care programs
• Experience developing and implementing health equity programs and interventions

Soft Skills:

• Strong analytical and critical thinking skills
• Excellent written, verbal and presentation skills
• Ability to work independently with minimal supervision
• Ability to effectively manage multiple priorities and projects simultaneously
• Ability to influence and collaborate within a highly matrixed organization.
• Strong collaboration and relationship-building skills
• Have limited distractions in the work environment

*All Telecommuters 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 $91,700 - $163,700 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.

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