Clinical Quality Manager

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

 

This Clinical Quality Manager assists with implementing and overseeing quality measures for value-based programs and initiatives, with a strong emphasis on quality metric performance, coding accuracy, regulatory compliance and continuous improvement. This role combines strategic oversight to enhance productivity and secure compliance with current quality standards and initiatives by evaluating workflow and efficiency and providing practice/provider specific recommendations and interventions while working with the quality team in developing and implementing plans and goals to assist clinicians in increasing their quality capture, Risk Adjustment and documentation.  The Clinical Quality Manager tracks, monitors, and trends performance to improve business objectives. The Clinical Quality Manager will assist with quality reporting, EMR processes, data validation and data extraction. The Clinical Quality Manager helps with creating client-facing resources and education in the areas of quality measures and risk coding. 

 

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

 

Primary Responsibilities:

• Monitor and manage coding and quality performance across multiple clinics and regions, using analytics to identify trends, set benchmarks, and develop corrective action plans.
• Use available population health tools, qualified registries, payor portals and payor reports to create actionable reports for clients and staff.
• Assist with the collection, validation and interpretation of quality and coding data from practices.
• Ensure coding and documentation compliance with applicable standards (e.g., ICD-10, HEDIS, NCQA).
• Engage with practices and third-party vendors to ensure optimal performance and service delivery.
• Develop and implement training programs and performance documentation including process workflow, guides, and on-boarding materials.
• Analyze data related to value-based programs, quality outcomes, and coding efficiency, present findings to director of Quality.
• Collaborate with quality ream and operational staff to align clinical and operational goals and meet NCQA, CMS and ACO standards.
• Effective communicator with internal teams and external clients.
• Serve as an initial point of contact for any issues or concerns from staff or external clients
• Provide all coverage when director is unavailable
• Maintains scheduling of events and represent the company when needed
• Ability to work independently
• Excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage several projects.

 

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:

• Experience with HCC coding, Managed Care, HEDIS and Medicare ACO Quality Measures
• Proficiency in data analysis and quality reporting
• Demonstrated experience with EMR and billing systems
• Demonstrated proficiency using MS Excel (specifically Pivot Tables, VLOOKUP, advanced formulas, charts, graphs, dashboards)
• Technical proficiency in Smartsheet
• Demonstrated knowledge of HIPAA standards and regulations with experience transmitting/sharing PHI and other data sensitive health information 

 

Preferred Qualifications:

• CPC or CRC Certification 
• Experience with Tableau
• Experience with SQL

 

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

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. 

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.