Accreditation/Clinical Quality Consultant - Remote in Florida

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Responsible for all aspects of NCQA and HEA accreditations, Adverse and Critical Incidents, HSAG Annual Technical Report and CAHPS
• Responsible for the overall management and full accountability for NQCA Accreditation including but not limited to: Trilogy Documents, related committee presentations, CAHPS, Health Equity Accreditation and any related action plans
• Completion and timely submission of required documents: QI Program Description, QI Workplan, QI Evaluation, BOD Presentation, CAHPS Report and Action Plan, MRR Summary
• Management of Adverse (AI) I and Critical Incidents (CI) reporting. Working with CM teams on detailing findings of Root Cause Analysis associated with AIs and CIs
• Working with CM teams on detailing findings of Root Cause Analysis associated with AIs and CIs
• Proactively manages and responds to rapidly changing state requirements and environments
• Oversees the implementation of plan quality management components, including quality management committee oversight and governance structure
• Collaborates across business segments to attain or maintain the plan's compliance with NCQA accreditation standards and contractual requirements as they apply to the quality management program
• Develops and maintains positive relationships with the state External Quality Review Organization (EQRO) within the scope of the quality management program
• Provides explanations and information to others (i.e. providers, provider staff, intradepartmental teams) on issues and data around Quality measures
• Analyze metrics, summarize key business learning, and translate into tactical plans (PCOR, Practice Assist and other Data lists)
• Make recommendations and implement quality improvement interventions based objective information
• Ensure work is meeting regulatory requirements
• Communicate ideas clearly and concisely to multiple audiences
• Use data analytics, assist with the identification of opportunities for quality improvement at multiple levels

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 of experience in NCQA accreditation
• 2+ years of experience in Managed Care
• 2+ years of experience coordinating the development and implementation of maintaining continuous survey readiness across the organization, including creating, updating, and revising policies
• 2+ years of experience maintaining a working knowledge of applicable CMS and HIPAA standards and regulations
• Intermediate level proficiency in MS Word and Excel
• Ability to develop and coordinate delegation oversight mechanisms and act as liaison for the Health Plan
• Reside in state of Florida

Preferred Qualifications:

• Certified Professional in Healthcare Quality
• Experience in quality improvement and HEDIS
• Experience in bringing together cross-functional teams to complete projects
• Comprehensive understanding of Privacy Laws (HIPAA)
• Knowledge base of HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
• Proven excellent Verbal and written communication skills

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

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.