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Clinical Quality Analyst - Schaumburg, IL - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Schaumburg, IL Schaumburg, Illinois |
About this job
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The Clinical Compliance Analyst will be responsible for quality and compliance initiatives for the prior authorization department. The Clinical Compliance Analyst will work independently to manage clinical quality and process improvement projects such as Quality Improvement Projects and Corrective Action Plans. The Clinical Compliance Analyst will assist with accreditations and work independently on delegations and licensing in support of URAC, NCQA and state utilization review licensing requirements. The Clinical Compliance Analyst will coordinate and revise department policies and procedures. This position will require knowledge of core PBM/managed care functions with a focus on clinical functions such as formulary management, Pharmacy and Therapeutics (P&T), prior authorization, appeals, drug utilization management and clinical program operations.
Primary Responsibilities:
Initiate and manage quality and compliance projects that address CMS, URAC and NCQA requirements. Address state-specific utilization review licensing requirements
Initiate and manage clinical process improvement projects
Prepare deliverables for quality and compliance related meetings and committees
Work collaboratively with subject matter experts and PA Support to ensure that Policies & Procedures, Standard Operating Procedures, and department Desk Top Procedures are developed and maintained according to CMS, URAC, NCQA and state requirements
Work with Training department to ensure all training materials are compliant with state and federal regulations as well as accreditation standards
Work collaboratively with the Prior Authorization Quality team to perform various internal monitoring and testing functions to insure that documented policies, procedures and processes are being followed and that quality assurance checks are in place to help identify gaps or weaknesses
Other activities as determined by the Manager, Clinical Compliance
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The Clinical Compliance Analyst will be responsible for quality and compliance initiatives for the prior authorization department. The Clinical Compliance Analyst will work independently to manage clinical quality and process improvement projects such as Quality Improvement Projects and Corrective Action Plans. The Clinical Compliance Analyst will assist with accreditations and work independently on delegations and licensing in support of URAC, NCQA and state utilization review licensing requirements. The Clinical Compliance Analyst will coordinate and revise department policies and procedures. This position will require knowledge of core PBM/managed care functions with a focus on clinical functions such as formulary management, Pharmacy and Therapeutics (P&T), prior authorization, appeals, drug utilization management and clinical program operations.
Primary Responsibilities:
Initiate and manage quality and compliance projects that address CMS, URAC and NCQA requirements. Address state-specific utilization review licensing requirements
Initiate and manage clinical process improvement projects
Prepare deliverables for quality and compliance related meetings and committees
Work collaboratively with subject matter experts and PA Support to ensure that Policies & Procedures, Standard Operating Procedures, and department Desk Top Procedures are developed and maintained according to CMS, URAC, NCQA and state requirements
Work with Training department to ensure all training materials are compliant with state and federal regulations as well as accreditation standards
Work collaboratively with the Prior Authorization Quality team to perform various internal monitoring and testing functions to insure that documented policies, procedures and processes are being followed and that quality assurance checks are in place to help identify gaps or weaknesses
Other activities as determined by the Manager, Clinical Compliance
Requirements
Required Qualifications:
H.S Diploma
Excellent verbal and written communication skills
Good knowledge of CMS, URAC and NCQA compliance requirements. Strong knowledge of the PBM/managed care industry
Strong knowledge of clinical quality improvement processes
Excellent organizational, project management and time management skills
Demonstrated ability to work collaboratively in a team environment
Excellent interpersonal and problem-solving skills
Proven ability to meet deadlines required
Strong customer service orientation and commitment to professionalism
Preferred Qualifications:
CatamaranRX/OptumRX experience strongly preferred
1+ year of PBM or Healthcare experience
Careers with OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing 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.
H.S Diploma
Excellent verbal and written communication skills
Good knowledge of CMS, URAC and NCQA compliance requirements. Strong knowledge of the PBM/managed care industry
Strong knowledge of clinical quality improvement processes
Excellent organizational, project management and time management skills
Demonstrated ability to work collaboratively in a team environment
Excellent interpersonal and problem-solving skills
Proven ability to meet deadlines required
Strong customer service orientation and commitment to professionalism
Preferred Qualifications:
CatamaranRX/OptumRX experience strongly preferred
1+ year of PBM or Healthcare experience
Careers with OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing 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.