EPSDT Clinical Quality Analyst - Remote in Arizona

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Are you passionate about improving health outcomes for children? Join us in transforming healthcare by supporting our Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) program initiatives. This is your opportunity to contribute to comprehensive health programs that ensure children receive the preventive services and treatments they need to thrive.

As a Clinical Quality Analyst focusing on EPSDT, you will play a vital role in the strategy and implementation of clinical quality improvement initiatives. Your expertise will directly impact the health and well-being of children, guiding our efforts to meet regulatory standards and enhance service delivery.

Working Schedule: Monday through Friday between the hours of 8 am to 5 pm. Fulltime telecommute position with home-based office. Must be able to attend onsite meetings, when needed up to 10% of the time.

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

Primary Responsibilities:

• EPSDT Program Monitoring and Compliance:
  • Monitor performance on EPSDT requirements including well child visits, developmental screenings, oral health, immunizations, vision/hearing screenings, lead testing, and other mandated periodicity schedule components
  • Review claims, encounters, and supplemental data to evaluate compliance with AHCCCS EPSDT standards
  • Track key EPSDT indicators (preventive visit timeliness, screenings completed, overdue services) and identify emerging trends, barriers, and improvement opportunities
  • Ensure program adherence to AHCCCS Medical Policy Manual (AMPM Policy 430) EPSDT requirements, including required periodicity schedules, and reporting expectations
  • Support EPSDT program workflow design
  • Identify process inefficiencies and recommend improvements
• Oversee projects aimed at increasing member utilization of EPSDT services, ensuring children receive necessary screenings and interventions
• Quality Improvement Activities: Assist Quality Manager/QM Director in implementing quality improvement activities specific to EPSDT, contributing to the health plan's compliance with state and federal regulations
• Regulatory Compliance: Support timely submission of regulator required or internal EPSDT reports and adherence to state EPSDT reporting requirements
• Audit Support: Assist with provider audits which may include but are not limited to dental chart and fluoride varnish audits to ensure compliance with EPSDT protocols
• Maintain EPSDT program supporting documentation including Standard Operating Procedures
• AzEIP Coordination Support: Collaborate with UHC EPSDT Coordinator to coordinate actions related to the Arizona Early Intervention Program, providing essential support and services for children with developmental delays or disabilities
• Assist with Member and Provider outreach as assigned, based on department needs
• Other activities as assigned, based on department needs

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 project management or quality improvement experience, preferably in a Medicaid or Medicare environment
• 2+ years of experience with data manipulation and reporting software (Microsoft Excel, Access, etc.) to prepare analytical reports
• 2+ years of experience with verbal and written communication to support effective collaboration with internal teams and external partners
• Reside in Arizona and be able to travel to the local office up to 10% of the time based on business needs

Preferred Qualifications:

• Experience with EPSDT and/or quality improvement initiatives related to pediatric care
• Familiarity with Snowflake environments or a willingness to learn
• Medicaid/Medicare experience
• Proven ability to solve complex problems and enhance program effectiveness

*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 hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

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.