Job Description

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.

Positions in this family require a nursing degree or license (RN). These positions may include health promotion and services, clinical services, delivery of quality initiatives and clinical care, population health, case management, nurse line, claims review, patient delivery, risks assessments, affordability promotion to include cost analysis, utilization, and quality data improvements, social needs, and social determinants of health needs.

Positions in this family require a nurse with current licensure. This function includes nursing (with current licensure) roles which manage development and implementation of population health strategic initiatives. Advises leadership on improvement opportunities regarding health promotion and disease prevention programs and clinical activities that impact population health and social determinants of health needs.

The Population Health Strategic Consultant – NCQA Lead is a subject matter expert responsible for guiding the organization’s strategies to achieve and maintain National Committee for Quality Assurance (NCQA) accreditation, including but not limited to Health Equity Accreditation, Performance Improvement Projects, and other related programs. This role involves leading cross-functional teams, developing comprehensive strategies to meet NCQA requirements, and ensuring alignment with organizational goals to improve population health outcomes.

Positions are accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS, and STARs gap closure, coding accuracy, facilitating effective education and reporting, effective super utilizer engagement (e.g. members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support.

If you reside in the state of Louisiana, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges.

Primary Responsibilities:

• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Solves moderately complex problems and/or conducts moderately complex analyses
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Translates concepts into practice
• Provides explanations and information to others on difficult issues
• Mentors, provides feedback, and guides others
• Acts as a resource for others with less experience
• Visit providers’ offices to educate them on clinical measures, disease prevention programs and communication resources
• Provide providers with list of gaps in member services/screenings to improve the overall health of members
• Perform chart reviews for HEDIS and for State Required Audits
• Serve as SME for assigned HEDIS/CMS measures to assist with rate improvement and provider knowledge
• Collaborates with providers to execute the implementation of the clinical quality data initiatives related to HEDIS
• Provide analytical interpretation of HEDIS reporting, including executive summaries to plan and provider groups weekly, Monthly, Bi-monthly, and/ Quarterly
• Serve as SME for Preventative health topics,
• Assist with performance improvement projects
• Special projects as assigned
• Work with patient and patient’s care team to coordinate change readiness, needs assessment, and assist with developing an individualized treatment care plan
• Implementation of Clinical and Quality initiatives
• Affordability promotion to include cost analysis, utilization, and quality data improvements

Additional Responsibilities:

• Responsible for ongoing management of provider practice and community education on state specific quality measures
• Work with Quality Director to coordinate an interdisciplinary approach to increased provider performance and disease management
• Provider education regarding the quality improvement program involving analysis and review of quality outcomes at the provider level, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, social determinants of health needs and pay for performance initiative while improving health outcomes for our members
• Focus on tasks that occur in accordance with State, CMS, or other requirements as applicable
• Role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using clinical practice guidelines, HEDIS, CMS, NCQA and other tools
• Assist in the development and implementation of disease specific population health programs

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:

• Undergraduate degree
• Current unrestricted RN licensure in state of Louisiana
• 3+ years clinical nursing experience, preferable in managed care environment
• Louisiana driver’s license with clean driving record
• Experience presenting to others
• Access to high-speed internet

Preferred Qualifications:

• CPHQ Certification
• Proficient with working within a Windows environment, utilizing Outlook and advanced skills with Microsoft Excel
• Ability to created spreadsheets in Excel
• Experience working with provider offices
• Experience working with the Medicaid/Medicare Population
• Comfort with reading reports and analyzing data

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

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. 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.

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