Senior Clinical Quality Analyst - Latham, NY

The Senior Clinical Quality Analyst position will be based in Latham, NY and will be responsible for the following:


Gathering and analyzing data

Identifying barriers and root causes of QI issues and performance gaps
Creating reports and annual core documents
Ensuring compliance with relevant accreditation standards, which includes:

Creating analysis and summary documents of various projects for accreditation organizations (URAC) and

Assisting the Director in interventions/data analysis of assigned ongoing quality improvement activities (QIAs)

Assisting with facilitation and coordination of quality improvement committee meetings and running work groups - This includes setting agendas and taking meeting minutes.

Conduct random selection of appeal and denial cases and conducting monthly appeal and denial documentation audits

Helping prepare for audits

Coordinating review and the investigation of potential quality of care complaints and potential sentinel events

Monitoring and/or documenting review of key performance indicators and facilitating CQI process as necessary

Participating in projects and activities to support HEDIS or other best practice standards improvement

Assist in monitoring and enhancing Empire Disease Management Programs.

Assist in preparing documentation and summary reports for customer (quarterly, annual)

Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including accreditation. Conducts clinical quality audits and may also be responsible for URAC or NCQA requirements. 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.

OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

At OptumHealth, you will perform within an innovative culture thats focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact thats greater than youve ever imagined.

 RequirementsRequirements:

• Undergraduate degree
  
• Minimum 2 years experience in data collection and analysis
  
• Minimum 3 years experience in managed care, insurance or the healthcare industry experience
  
• Proficiency in Microsoft Office products Excel, Word,

Preferred/Asset Qualifications:

• Masters degree in a behavioral health or related field
  
• Behavioral health licensure is preferred (e.g. LCSW, MFT, RN, PhD, etc.)
  
• Knowledge of NCQA and URAC regulations
  
• Behavioral health experience
  
• Experience developing reports
  
• Quality improvement experience

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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Country: USA, State: New York, City: Albany, Company: UnitedHealth Group.