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Clinical Careers at UnitedHealth Group. The days when people only connected with health care when they were sick are over. Today, we’re leading the health care revolution with a growing array of proactive, holistic tools and resources to encourage total well-being for millions of our customers. our integration model and network of over 80,000 providers allows us to affect meaningful change on a huge scale, and positions us well ahead of our competitors. We’re going beyond basic care to health programs integrated across the entire continuum of care. We’re inventing the future of health care. Join us. Change your life by doing your life’s best work.SM

Clinical Quality Consultant - Medicare STARS - CA Telecommute

Job Description:

At OptumHealth, you will perform within an innovative culture that is focused on transformational change in the health care system.  You will leverage your skills across a diverse and multi-faceted business.  And you will make contributions that will have an impact that is greater than you have ever imagined.

In this career, you'll drive consistency, efficient processes and share best practices - in a collaborative effort with the providers - designed to facilitate a minimum 4 STAR rating. You'll actively participate in quality improvement initiatives, develop recommendations for quality remediation plans, and create tools and databases to capture relevant data.

This is a work at home opportunity with approximately 50% local travel to provider sites in the Oakland, Sacramento and San Jose areas.


  • 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 United Healthcare's Regional Vice President, Administrative Call Center Team, Health Plan Medical Directors, and other Health Plan and Optum team members to assure that all STARS activities are planned and executed

  • Assist OPTUM and UnitedHealthcare in development of training and analytical materials for Stars and HEDIS

  • Lead 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 or required by the Health Plan and the Director of Market Consultation

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

  • Identify and assess decision makers and other key provider group personal with a focus on identifying barriers to achieving targeted outcomes. Focus communication and efforts accordingly

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

Job Requirements:

Required Qualifications:

  • Undergraduate degree or equivalent experience

  • 5+ years associated business experience with health care industry

  • Professional experience persuading changes in behavior

  • Strong knowledge of the Medicare market, products and competitors

  • Knowledge base of clinical standards of care, preventive health, and Stars measures

  • Experience in managed care working with network and provider relations/contracting

  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)

  • Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, PowerPoint and MS Access skills required

Preferred Qualifications:

  • Strong communication and presentation skills

  • STARS experience highly preferred

  • Strong 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

  • Strong 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

  • Medical/clinical background highly desirable

  • Undergraduate degree preferred, post graduate degree highly preferred

We're on a mission to change the face of health care. And at OptumHealth, the largest health and wellness business in the U.S., we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, as a thriving part of the UnitedHealth Group family of companies, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all.  Join us and learn why there is no better place to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: STARS, CMS, Medicare, Medicaid, clinical quality analyst's Advice

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Job Category: Management
Health Care
Job Reference Code: UHG-554509-2
Position Type: Full-Time
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