For you, quality counts. For UnitedHealthcare, part of the UnitedHealth Group family of businesses, delivering quality care starts with processes and documentation standards that are the best in our industry. As a Senior Clinical Quality Analyst, you'll be a force for positive change, guiding the development of comprehensive care plans that will help others live healthier lives. Join us and help guide our efforts to improve the patient experience. This position is focused on continuous quality improvement through excellent customer/client support related to CMS reporting requirements and interpretation, CMS protocols impacting UM operations, reporting for external customer audits and IT enhancements to support new protocols. Responsibilities include researching and troubleshooting client requests, triaging and responding to escalated issues as they relate to a customer's ad-hoc reporting, adherence to CMS protocols, and completion of CMS reporting requests. This is a Monday – Friday, day hours position. This position ideally would be located onsite in Eden Prairie, MN with the opportunity to work at home on a part time bases. May consider other locations as a 100% telecommute position. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:Uses pertinent data and facts to identify and solve a range of problems within area of expertise, health plan & employer group UM operationsRespond to work direction from outside the team (e.g. Compliance, Account Management) and follow through on requests in a timely manner which may include direct customer contact requiring high degree of professionalismInvestigates non-standard requests and issues with some assistance from othersPartner with other departments to respond to client/customer requests timely and accuratelyAnticipate customer needs and proactively identifies solutionsOversee Quality Assurance (QA) process for the monthly and quarterly submissions of customer required reports through to final report production to ensure accuracy of all data elementsMaintain and adhere to reporting schedule and schedule meetings as necessary to coordinate resources responsible for supporting the reporting processIn partnership with others, gather and interpret CMS protocols requiring report changes for Medicare required reporting to assess appropriate groupings of changes to submit to the reporting teamTrack system/platform enhancements for bundling into IT Projects and participate as a SME through implementationIdentify, prioritize, and proactively communicate potential barriers or risks to key stakeholders. Share information across team members to increase overall team knowledge and understanding of concepts, and to ensure consistent applicationPlans, prioritizes, organizes and completes work to meet established objectives and deadlines
Required Qualifications: 3+ years of Healthcare experience focused on adherence or compliance in Utilization Management Prior knowledge/experience with account based products1+ years of experience within a matrix organization, healthcare or insurance company2+ years of exposure to requesting reports/ managing creation of reports, participation in IT projects, etc.Solid MS Excel skills including use of formulas, pivot tables, filters and basic macrosPreferred Qualifications: Experience with Medicare and CMS reportingExperience working as behavioral health clinicianProject management skills – basic understanding of milestones, prioritization, escalation, and resource management2+ year's experience utilizing platforms such as Linx, ICUE, ISETSkills and Abilities:Interpersonal Skills - ability to deal and work with people with different leadership levels and backgrounds. Demonstrated ability to build and maintain long term internal business relationships. Decision-Making Skills - capable of arriving at the appropriate decisions after weighing the pros and cons of all the options. Communication Skills - excellent verbal and written communication skills in addition be a good listener to give value to the opinion and suggestion of others. Accountability – Takes ownership of tasks, performance standard and quality results. Maintains necessary attention to detail to achieve high level performance. Problem Solving - Solution Driven Approach Skills - demonstrate ability to review problem, troubleshoot root cause issues and determine path to resolution. Flexible - Able to work effectively in a changing environment and contribute innovative ideas.Accuracy and Efficiency - Excellent time management and organizational skills balancing multiple priorities. Accurate when processing detailed tasks while meeting deadlines.Self-starter - able to independently, drive work and prioritize work with minimal oversight.If you're the kind of thinker and leader who wants to bring your contribution to a new level every day, here's your 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. Job Keywords:Clinical Quality Analyst, QA, CMS, Medicare Compliance, Medicare Reporting, Audit Analyst, telecommute, Eden Prairie, MN
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.