Remote Sr Clinical Quality Analyst


Apply Now

Requisition Number: 2211824
Job Category: Medical & Clinical Operations
Primary Location: Albuquerque, NM
(Remote considered)

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.

Engagement with providers and community resources will be very important. Key metrics and measures will be developed to assess member health in aggregate.  In partnership with other members of the clinical team, a component of the role will include provider education and monitoring of quality improvement programs.  This includes analysis and review of health outcomes at the provider and aggregated patient-level monitoring, measuring and reporting on key metrics meeting quality standards, state contractual requirements, , and pay for performance initiatives.  This position will focus on planning and implementing initiatives that are needed and do so in accordance with State, CMS, NCQA, and/or other requirements as applicable.

This position is full – time (40 hours / week) Monday – Friday. Employees are required to have flexibility to work any of our 8 – hour shift schedules during our normal business hours of 8am to 5pm.  It may be necessary, given the business need, to work occasional overtime. This position is a remote – based position with a home – based office.

If you are located within New Mexico, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

  • Assesses trends in population/quality measures and identifying opportunities for quality improvement.
  • Support accurate and timely issue resolution and data reporting and provide overall Prospective customer support
  • Support the monitoring and tracking of custom measure / deliverable development with our external vendor and internal partners
  • Collaborate with applicable internal stakeholders to obtain in-depth information / data about internal / external customer requirements for technology supporting Quality Optimization and Insights
  • Support research to help establish current and emerging customer / market needs and trends (e.g., competitor technology analysis)
  • Gather and document requirements from the client / business while focused on process improvement, workflow, benchmarking and/or evaluation of business processes and/or configuration
  • Gather / analyze / validate applicable data from internal and external sources (e.g., clients, prospects, potential customers) to identify customer / market characteristics, needs, and problems (e.g., market opportunities, financials, technology trends, user preferences industry / regulatory / legal standards, internal product trends)
  • Develop an understanding of the competitive quality metrics technology landscape (e.g., strengths, weaknesses, gaps, product portfolios, win / loss analysis)
  • Document / communicate market characteristics and needs to applicable stakeholders (e.g., product management)
  • Serves as a team support resource on complex and / or critical issues
  • Reviews work performed by others to ensure data accuracy
  • May support functional or segment teams or projects
  • Provides explanations and information to others on complex issues
  • Motivates and inspires other team members
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Support the development of ad-hoc reports

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: 

  • 3+ years clinical or healthcare experience
  • Intermediate software applications skills that include, Microsoft Word, Excel, PowerPoint
  • A dedicated work area established that is separated from other living areas and provides information privacy
  • Must currently reside in New Mexico
  • Ability to travel locally up to 25% of the time
  • Ability to review data and make clinical interventions and consult others

Preferred Qualifications:  

  • Current unrestricted Registered Nurse (RN) licensure in the state of NM or Licensed Clinical Social Worker (LCSW)
  • CPHQ Certification
  • Systems Analyst or Business Analyst experience
  • Experience working in Medicaid and/or Medicare
  • Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
  • Background in Managed Care

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.