Sr Hedis Clinical Quality Analyst - Remote

As a key contributor in the clinical operations of the New Mexico health plan, the Clinical Quality Analyst, senior, will work closely with the Leadership team to coordinate an interdisciplinary approach to care. This will include a focus on health promotion, social determinants of health (SDoH), Clinical Quality improvement and management programs including accreditation. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools.

This position is full - time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8 - hour shift schedules during our normal business hours of 8am to 5pm. It may be necessary, given the business need, to work occasional overtime. This position is a remote - based position with a home - based office.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Solves moderately complex problems and/or conducts moderately complex analyses
• Perform and/or facilitate functions ensuring Prospective and HEDIS® quality reporting requirements are met in accordance with NCQA, CMS and State technical specifications
• Collect Quality data and/or information based on applicable standards, state/federal or other regulations, customer or consumer
• Identify appropriate sources for data or information either internally or externally and collect data/information
• Develop effective methods for data/information collection
• Identify appropriate data platform or application (e.g., data bases, Intranet source, Internet source) and utilize to collect data or information
• Investigate Quality problems identified and collect additional information to close gaps
• Work cross functionally and coordinate with others internally or externally to gather information; overcome challenges to obtaining needed information
• Perform and/or facilitate functions ensuring Prospective and HEDIS® quality reporting requirements are met in accordance with NCQA, CMS and State technical specifications
• Mine data and/or information to identify inconsistencies, trends, other information needed, etc. (e.g., develop and/or run data queries)
• Analyze and interpret data or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant and/or provide explanations or updates when data/information (e.g., clinical, administrative) are not accurate or unclear
• Explain the characteristics of the data/information (e.g., clinical, administrative) including any unique attributes
• Identify Quality improvement or intervention opportunities and work cross-functionally to develop interventions or recommendations
• Read and interpret standards/requirements and/or technical specifications (e.g., structure and process, CMS star ratings, URAC, NCQA/HEDIS/ CAHPS/member satisfaction specifications, SNP)

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:

• 3+ years HEDIS or CMS stars submission experience
• Knowledge of social determinants of health in rural and urban setting in the Southwest
• Intermediate software applications skills that include, Microsoft Word, Excel, PowerPoint
• A dedicated work area established that is separated from other living areas and provides information privacy
• Must currently reside in New Mexico
• Ability to review data and make clinical interventions and consult others
• Ability to travel locally up to 25% of the time

Preferred Qualifications:

• Current unrestricted Registered Nurse (RN) licensure in the state of NM or Licensed Clinical Social Worker (LCSW)
• CPHQ Certification
• Experience working in Medicaid and/or Medicare
• Systems Analyst or Business Analyst experience
• Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, approach and the managed care industry
• Background in Managed Care

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.