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Clinical Quality Consultant - Northern California Region

UnitedHealth Group

Eureka, CA
Job Code:
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Job Details

Clinical Quality Consultant - Northern California Region(Job Number:716698)

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.
Primary Responsibilities:
  • 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 Quality Management
Primary Location US-CA-Eureka
Other Location US-CA-Crescent City, US-CA-Redding, US-CA-Chico
Organization RQNS Ops
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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