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Senior Clinical Quality Analyst - Boise, Idaho (Hybrid) at UnitedHealth Group

Senior Clinical Quality Analyst - Boise, Idaho (Hybrid)

UnitedHealth Group Work From Home, IL Full-Time

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.

For Optum Idaho, Quality Improvement is not a department, but a central tenet in the way we conduct all aspects of our operation.  We are continually monitoring multiple areas of our performance; our impact on Members, families, other stakeholders, and providers; and constantly looking for ways to improve.  The core goal of our Quality Improvement (QI) program is straightforward: improved quality of care and service for Members utilizing evidence-based best practices.  

The Senior Clinical Quality Analyst is a key member of the Quality Management and Improvement (QMI) Department within the Idaho Behavioral Health Plan (IBHP) and has responsibility for supporting all quality management and reporting functions in accordance with policy and NCQA standards.  They work in conjunction with the Quality Director and the Compliance Director in the coordination, implementation, and management of quality functions.  

The Senior Clinical Quality Analyst will coordinate all aspects of Quality Data and Reporting in accordance with CMS and state contract requirements. This position supports the development of the Annual Quality Work Plan, the Annual Quality Evaluation, the Quality Assurance Performance Improvement (QAPI) Program Description, and monthly, quarterly, and annual reports. This position coordinates the QAPI Committee meetings as well as the Utilization Management meetings. This position is a key contributor to the External Quality Review (EQR) and Performance Improvement Project processes.

The Senior Clinical Quality Analyst will serve as back up for the following operations processes and must abide by State and federal governmental regulatory requirements and contracted IBHP requirements related to member critical incidents, quality of care concerns, appeals, complaints, provider disputes, adverse benefit determination notifications, and medical record requests, They consult and collaborate with all levels of staff on identified and potential risk issues.

The Senior Clinical Quality Analyst will support developing and implementing various process improvement initiatives as initiated by the Quality Director.

If you are located in Idaho, you will have the flexibility to telecommute* as you take on some tough challenges.  Schedule will include working 3 days in the Boise, Idaho office which must include Monday and Thursday.  The opportunity to work from home 2 days a week is available.    

Primary Responsibilities:

  • Compile and prepare reports for inclusion in outlines and initial drafts of the Annual Quality Work Plan, the Annual Quality Evaluation, and the Quality Assurance Performance Improvement Program Description
  • Subject matter expert regarding the Quality Data and Reporting requirements and processes
  • Analyzing Performance Measures 
  • Population Analysis
  • Analysis of Member Satisfaction Survey
  • Preparation and analysis of State Reports
  • Back up ensuring compliance with turnaround times for critical incidents, quality of care concerns, records requests, appeals, complaints, provider disputes, and adverse benefit determination notifications. 
  • Back up for tracking and processing Quality policies 
  • Performs customer service tasks by managing internal & external customer requests 

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:

  • Bachelor's Degree or equivalent work experience
  • 2+ years of health care experience
  • 1+ years of experience compiling, analyzing and reporting out on data to communicate trends and areas for opportunities to improve outcomes
  • Experience with analyzing data in Excel 
  • Ability to collect, analyze, and present data
  • Willing to work in the Boise office a minimum of 3 days per week
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Experience with Performance Improvement Projects
  • Experience with data entry and use of data tracking systems
  • Experience using the Web for research conducting purposes
  • Subject matter expert regarding statistical analysis

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

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