Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group is a global organization that delivers care aided by technology to help millions of people live healthier lives. As a Senior Clinical Quality Analyst, you will monitor and support health plan quality improvement initiatives, ensuring compliance with regulatory requirements and enhancing member care through data analysis and quality initiatives.
Responsibilities
- Support behavioral health quality improvement activities, performance improvement projects, and annual program deliverables for California health plan customers
- Collect, analyze, and interpret clinical and operational data to identify trends, risks, and opportunities for improvement in quality performance and member experience
- Prepare reports, summaries, dashboards, and presentation materials for internal leadership, committees, and external customers
- Partner with health plan customers and internal stakeholders to monitor quality metrics, support corrective actions, and advance behavioral health quality initiatives
- Support compliance with California and national quality requirements, including applicable state and federal regulations and accreditation standards such as DMHC, NCQA, HEDIS, and URAC
- Conduct quality of care reviews and investigations related to enrollee grievances, identified quality concerns, and sentinel events, and document findings in accordance with established processes
- Assist in preparing audit-ready documentation and evidence for quality management reviews, audits, and accreditation activities
- Support quality management committees and workgroups through agenda development, meeting materials, follow-up tracking, and documentation of key actions
- Review clinical documentation and collaborate with licensed clinicians and operations partners to promote compliance with documentation standards and community standards of care
- Contribute to behavioral health HEDIS and related performance improvement efforts by helping design, implement, and monitor interventions in partnership with customers and cross-functional teams
Skills
- Current, unrestricted California behavioral health license (e.g., LMFT, LCSW, LPCC, Psychologist, or other independently licensed behavioral health clinician, as applicable)
- Current California residency
- 3+ years of professional experience in behavioral health, clinical quality, quality management, utilization management, case management, or a related healthcare function
- 1+ years of experience in a managed care, health plan, delegated entity, or behavioral health quality environment
- Experience using Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint, with the ability to create, edit, and present reports and documents
- Access to reliable high-speed internet and a home workspace suitable for remote work
- Experience collecting, analyzing, and presenting clinical or quality performance data
- Experience supporting performance improvement projects or using data to inform intervention strategies and operational improvements
- Experience preparing audit materials, annual evaluations, committee documentation, or accreditation evidence
- Working knowledge of California behavioral health regulatory and accreditation requirements, including DMHC, NCQA, HEDIS, and URAC standards
- Proven solid written and verbal communication skills, including experience presenting findings and recommendations to customers or leadership
- Demonstrated ability to manage multiple priorities independently in a highly collaborative environment
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
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