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UnitedHealth Group Senior Clinical Quality Analyst, Operations Specialist - Boise, ID in Boise, Idaho

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

For Optum Idaho, Quality Improvement is not a department, but a central tenet in the way we conduct all aspects of our operation. We are continually monitoring multiple areas of our performance; our impact on Members, families, other stakeholders, and providers; and constantly looking for ways to improve. The core goal of our Quality Improvement (QI) program is straightforward: improved quality of care and service for Members utilizing evidence-based best practices.

*This position is based on site in the Boise, Idaho office.*

The Senior Clinical Quality Analyst is a key member of the Quality Management and Improvement (QMI) Department within the Idaho Behavioral Health Plan (IBHP) and has responsibility for ensuring all quality management and peer review functions are maintained in accordance with policy and NCQA standards. This person will work in conjunction with the Quality Manager and the Medical Director in the coordination, implementation, and management of quality functions.

The Senior Clinical Quality Analyst will coordinate all aspects of the External Quality Review (EQR) process in collaboration with the Quality Manager. This person will support the EQR process to ensure active, ongoing preparation to ensure readiness for a successful review process.

The Senior Clinical Quality Analyst will be the subject matter expert for the quality administrative processes as related to implementing inpatient services to the IBHP.

The Senior Clinical Quality Analyst will serve as back up for the following operations processes and must abide by state and federal governmental regulatory requirements and contracted IBHP requirements related to member critical incidents, quality of care concerns, appeals, complaints, provider disputes, adverse benefit determination notifications, and medical record requests. This person will consult and collaborate with all levels of staff on identified and potential risk issues.

The Senior Clinical Quality Analyst will serve as back up for providing expertise or general support in reviewing, researching, investigating, negotiating, and resolving all types of critical incidents, and quality of care concerns, and communicate with appropriate parties regarding issues, implications, and decisions.

The Senior Clinical Quality Analyst will support developing, implementing, and administering various process improvement initiatives as initiated by the Quality Department.

Primary Responsibilities:

  • Subject matter expert regarding the EQR process

  • Back up on Performance Improvement Projects

  • Back up ensuring compliance with turnaround times for critical incidents, quality of care concerns, records requests, appeals, complaints, provider disputes, and adverse benefit determination notifications.

  • Back up for Quality core documents as in Work Plan Description, Quality Program Description, Annual Quality Evaluation, and policies and procedures

  • Prepare associated state reports

  • Perform customer service tasks by managing internal & external customer requests

  • Analyze aggregate data and report on data as needed

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:

  • Bachelor's Degree or equivalent work experience

  • 2+ years of health care experience

  • 1+ year of experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes

  • Demonstrated ability to collect, analyze, and present data

  • Demonstrated ability to create, send, and modify documents in Microsoft Word, Excel, and PowerPoint

Preferred Qualifications:

  • Subject matter expert regarding the EQR process

  • Experience with Performance Improvement Projects

  • Experience with data entry and use of data tracking systems

  • Experience using the Web for research conducting purposes

  • Solid verbal and written communication skills

  • Acute critical thinking ability

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: Quality, Quality Analyst, Quality Management, Quality Improvement, Clinical, Behavioral Health, External Quality Review, EQR, Performance Improvement, Data Entry, Data Tracking, Boise, ID, Idaho