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Quality Compliance Specialist - Telecommute - San Diego, CA

UnitedHealth Group

San Diego, CA
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Job Details

743943 Quality Compliance Specialist Telecommute San Diego CA

Quality Compliance Specialist - Telecommute - San Diego, CA (743943)

Position Description

In your field, learning never stops, and neither do you. You are continually pushing yourself to reach higher and go further; to do everything you can to ensure a positive outcome for our patients. Staying on top of your game and persevering in the face of challenge will be a big part of your success. And at every turn, you'll have the support of an elite and dynamic team. Join us in this role and you will use your diverse knowledge and experience to make health care work better for our patients, while doing your life's best work.(sm)
The Quality Compliance Specialist supports organizational efforts to improve quality program compliance and performance for the Medicaid line of business within the health plan. The position will be responsible for planning and implementing various quality improvement projects, and is also responsible for committee preparation, yielding data from multiple data systems for regulatory reporting, and performing data analysis to support quality improvement efforts. The position provides implementation and analytical support to ensure optimal operations within the Quality department.
35% of the role is supporting Quality Audits program activities for regulatory compliance, 25% of the role is data extraction and analysis for regulatory reporting and compliance, 25% of the role is supporting quality improvement projects, and 15% of the role is supporting Quality Committees (Quality Improvement Committee, Health Education Committee, Service Quality Improvement Subcommittee, Provider Advisory Committee. 

If you are located in San Diego, CA you will have the flexibility to telecommute* as you take on some tough challenges.  Must be able to travel locally and to the San Diego office up to 25%


Primary Responsibilities:
  • Provide support for the design, reporting, implementation, and management of Quality Improvement Projects (QIP) and initiatives per Department of Health Care Services (DHCS) requirements
  • Review DHCS All Plan Letters (APL) and Policy Letters, reconciling and revising policies and procedures to ensure compliance
  • Monitor data from external databases to ensure valid reporting to the DHCS for QIPs and Quality Audits. Prepare routine reports for timely submission to DHCS – abstract, validate, and prepare reports
  • Support the planning and coordination of Facility Site Reviews, Physical Accessibility Reviews (PARS), Medical Record Reviews, and Focused Audits, planning strategically to ensure all audits and subsequent follow up activities are completed by Clinical Practice Consultant Auditors (CPCA) timely and efficiently
  • Participate in State workgroup collaborative meetings to ensure operations are aligned to meet DHCS requirements, while incorporating other Managed Care Plans’ best practices
  • Provide administrative support in planning and facilitating Quality Committees. Prepare documents and reports, manage meeting schedule, compile meeting packets, and record minutes. Maintain list of attendees and Confidentiality statements. Send correspondence to external attendees. Submit record of meetings to DHCS
  • Provide administrative support in preparing evidence for regulatory audits and accreditation activities as conducted by DHCS, DMHC, and NCQA
  • Provide support as needed for Patient Access and Availability Study (PAAS) and corresponding corrective action plans
  • Offer support for Quality Department activities as needed
Required Qualifications:
  • Bachelor’s degree
  • 2+ years’ experience in clinical or Managed Care setting
  • 2+ years’ experience in Quality Management
  • 1+ year experience in developing and implementing performance improvement projects, data analytics, or using data to develop intervention strategies to improve outcomes
  • Demonstrated ability to manage multiple projects simultaneously
  • Working knowledge of DHCS, DMHC, NCQA, and HEDIS
Preferred Qualifications:
  • Master’s degree
  • Experience in preparing and managing documents for regulatory agencies
  • Experience working with clinical staff
  • Experience in planning Committee meetings 
  • Experience with quality measures such as HEDIS
  • Experience creating reports related to quality improvement/performance outcomes
  • Intermediate skill and experience with Microsoft Excel and Microsoft Word
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.



Job Keywords: Quality, Compliance, Auditor, DHCS, DMHC, NCQA, DHCS, managed care, audit, QI, quality improvement, HEDIS, data analytics, regulatory, Medicaid, Bachelor's degree, Master's degree, San Diego, SD, CA, California

Job Details

  • Contest Number743943
  • Job TitleQuality Compliance Specialist - Telecommute - San Diego, CA
  • Job FamilyMedical and Clinical Operations
  • Business SegmentCommunity and State

Job Location Information

  • San Diego, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 25 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusNon-exempt

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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