Medicare STARS Quality Analyst - Medicare & Retirement - West Valley City, UT or Las Vegas, NV - Full-time / Part-time

You are a thought leader who thrives on developing new solutions to solve tough challenges. As a critical member of our business analysis team, you will help rewrite the future of UnitedHealth Group. Here, you're analytical and innovative skills will help us with our mission of helping people live healthier lives. Yes, we share a mission that inspires. And we need your organizational talents and business discipline to help fuel that mission. Are you ready to analyze data and deliver bold, business-savvy ideas to impact the lives of millions?
 
As a Business Analysis Consultant, you will be empowered to support short and long term operational/strategic business activities; develop, enhance and maintain operational information and models that will have an impact on business decisions. In this leadership role, you will have the opportunity to take the contributions of analysts and create valuable solutions to improve the health care system. Join us! Your passion for performance can fuel your life's best work.(sm)
 
Research, develop and present new or existing strategies to improve the STAR quality performance of a contract or contracts within a given market. Reviews plan performance against expectations and facilitates or influences changes to campaign or targeting portfolio to improve performance. Will work extensively with internal or external business constituents. May involve implementing contract specific projects requiring project management. Requires extensive monitoring of activities and effectiveness for immediate modification.
 
Primary Responsibilities:

Performs complex conceptual analyses
Proactively develops solutions to improve contract performance that fit the unique needs of the market
Serves a STAR/ QUALITY SME to internal local teams and external providers
Serves as market SME to campaign leaders ensuring campaigns meet local market requirements and nuances
Serves as a key resource on complex and/or critical issues
Reviews work performed by others and provides recommendations for improvement. Alerts RVP to progress or obstacles
With RVP, forecasts plan performance
Lead functional or segment teams or projects
Provides explanations and information to others on the most complex issues/ quality technical standards
Motivates and inspires other team members
ANALYZE and Communicate Market Characteristics and Needs

Collaborate with applicable stakeholders to obtain appropriate market information/data including financial impact of star performance
Gather/analyze/validate applicable data from internal and external sources (e.g., Star analytics teams, and providers) to identify market characteristics/needs/problems
Demonstrate understanding of the competitive landscape (e.g., star performance of competitor by measure and their competencies/capabilities
Document/communicate market problems and characteristics and needs to applicable stakeholder
LEAD Local STAR Strategies

Perform appropriate analyses to help drive product strategies - HEDIS, CAPHS, KMI, Operational HOS measures, measures by key providers
Define providers and measures to pursue, based on market analyses and applicable business criteria (e.g., business strategies) and appropriate strategies
With RVP Define breakthrough goals and goals by group, goals for incentives
Develop value propositions for applicable audiences to drive success (e.g., providers, medical management, UHN)
Develop and communicate unique campaigns and proposals for local market needs. Lead charter development and ROI analysis and approval by applicable decision-makers
Provide input to regional and national programs and implication of programs on local market
DEVELOP detailed Plans

Define contract specific star monthly, quarterly and annual plans to drive improvement and prioritize efforts as necessary
Ensure alignment/linkage between all key business areas- RAF/Revenue, Affordability/Cost and  Growth with Quality/ Star  strategies
Establish status dashboards to drive reviews (e.g., provider gaps in care, provider MAPCPI activity, HQPAF return)
Identify and communicate provider group needs as input to star activities
Collaborate with functional support partners and other applicable stakeholders to design measure specific solutions and  business requirements that address market/provider problems/needs
IMPLEMENT Programs

Develop/deliver/ensure star/ quality training/education for applicable internal and external audiences (e.g., sales team, UHN, providers, medical management)
Champion use of applicable reports for improvement. Where reports are lacking identify solutions or alternatives
Develop/manage/oversee project plans to drive local programs
Develop required provider collateral, in collaboration with applicable business partners (e.g., Marketing, Clinical, Legal, Regulatory)
Provide consulting on proposed star campaigns or customizations, based on specific provider or market requirements and evolving business needs
Lead weekly, monthly multidisciplinary team meetings to review progress, discuss milestones, monitor action items
Engage external  customers ( key providers) as necessary to implement programs
MONITOR effectiveness 

Monitor and evaluate market performance on an ongoing basis, using applicable performance metrics (e.g., HEDIS, CAPHS, HOS, KMI, Operations, MAPCPi, gaps in care, provider outreach and engagement)
Manage  and monitor provider-specific outreach and engagement by Optum and UHN  as needed
Monitor virtual provider support outreach and scheduling and provide feedback internally
Alert RVP when programs are not meeting results or milestones. Strategize methods to get back on track
 

Required Qualifications:

Undergraduate degree or equivalent experience
Advanced with Excel and PowerPoint
Strong project management skills including ability to work with internal UHG teams to accomplish needs of the market
Ability to understand data management and speak to provider data needs and systems
Preferred Qualifications:

Healthcare/Health Plan/HEDIS knowledge
Clinical background/training (RN, NP, Pharm.D, etc.) or ability to absorb clinical quality specifications and speak with confidence
Solid knowledge of managed care requirements related to clinical quality
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: 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: Medicare, STARS, Quality Analyst, Medicare and Retirement, Healthcare, West Valley City, UT, Utah, Las Vegas, NV, Nevada