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Quality Improvement Specialist (Managed Care) - La Palma, CA

UnitedHealth Group

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732415 Quality Improvement Specialist Managed Care La Palma CA

Quality Improvement Specialist (Managed Care) - La Palma, CA (732415)

Position Description

Responsible for design, implementation and evaluation of Clinical Quality Improvement programs, including but not limited to, Medicare 5 Star, HEDIS and P4P. Develops and implements strategies to improve Quality of care and patient satisfaction metrics. The position will collaborate with Clinical Services, Network Management, Healthcare Economics, IT and other operations team to impact outcome, process and performance measures.


Primary Responsibilities:

  • Serves as Subject Matter Expert (SME) on Quality Measures and act as a resource in the analysis, development and execution of Quality programs

  • Responsible for validation and analysis of quality scores to provide quality measures improvement recommendations at the operations and provider office meetings

  • Creates / Updates quality improvement toolkit and other educational materials related to P4P, HEDIS, Medicare 5 Star, and Patient Satisfaction performance indicators

  • Provides insights on Quality programs efficiencies and effectiveness and implements work flows for IPA and providers and tracks progress towards meeting established goals

  • Performs data reconciliation from many different sources, while maintaining data accuracy

  • Performs (standard and non-standard) supplemental data collection, abstraction and validation as necessary

  • Provides feedback and solutions to Quality Improvement team, escalates any gaps and barriers to management

  • Per need, creates patient mailings and makes outbound patient calls for P4P, Stars and HEDIS clinical initiatives. Creates fax blast files for clinical initiatives

  • Participates in testing and validating the new / existing Business User applications, as necessary

  • Maintain up to date quality programs repository

  • Travel via auto to provider offices up to 25%

Required Qualifications:

  • 2+ years of managed care experience

  • 2+ years of quality improvement experience

  • Professional experience with and solid knowledge of HEDIS, CAHPS, and HOS

  • Intermediate level of proficiency with Excel, Outlook and Word

  • Valid California Driver’s License and proof of automobile insurance

Preferred Qualifications:

  • Bachelor's degree or higher or equivalent combination of education and work experience

  • Reporting and analytics experience

  • Experience with NCQA, IHA-PAP, CMS-STAR

  • Ability to work with minimal direction

  • Self-motivated with strong organizational and project management skills

  • Strong individual initiative skills to identify and manage outcome driven behavior / process change

  • Ability to multi-task

  • Exemplary communication and interpersonal skills

  • Dependable, punctual and willing to adapt to changing itineraries


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)


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: Managed care, Quality Improvement, Data Analysis, Analyst, Medicare, Provider, HEDIS, CAHPS, HOS, NCQA, IHA-PAP, STAR, La Palma, CA, California

Job Details

  • Contest Number732415
  • Job TitleQuality Improvement Specialist (Managed Care) - La Palma, CA
  • Job FamilyBusiness Operations
  • Business SegmentOptumCare

Job Location Information

    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 25 % of the Time
  • Telecommuter PositionNo
  • 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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