Clinical Program Consultant - Accreditations

UHG Newark, NJ

About the Job

Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including NCQA Health Plan accreditation as well as NCQA LTSS and Multicultural Healthcare distinctions. Conducts clinical quality audits, as necessary. Responsible for the reporting and analysis of member care quality and for developing plans and programs to support continuous quality improvement using HEDIS and other tools.
General Profile:
  • Reviews the work of others.
  • Develops innovative approaches.
  • Sought out as expert.
  • Serves as a project leader/ mentor.
Job Scope and Leveling Guidelines:
  • Anticipates customer needs and proactively develops solutions to meet them.
  • Serves as a key resource on complex and/or critical issues.
  • Solves complex problems and develops innovative solutions.
  • Performs complex conceptual analyses.
  • Reviews work performed by others and provides recommendations for improvement.
  • Authorizes deviations from standards.
  • May lead functional or segment teams or projects.
  • Provides explanations and information to others on the most complex issues.
  • Motivates and inspires other team members.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
  • Responsible for developing and preparing documentation for NCQA and other accreditation surveys submissions.
  • Works closely with regional quality staff, health plan staff, and internal business partners to build and document compliance with accreditation standards.
  • Interpret complex data and draws conclusions
  • Complete reports that provide analysis of data related to key quality projects.
  • May present results of data analysis to diverse stakeholders.  
  • Organizes and/or participates in readiness assessments in preparation for accreditation survey submissions.
  • May interface with accreditation agencies and other regulatory and compliance bodies.
  • Participates in the development and distribution of accreditation best practices.
  • Serves as a technical advisor for accreditation compliance
  • Develops policies and procedures that support accreditation activities.
  • Supports implementation of quality structure at regional and national levels.
  • Requires occasional overnight  travel for accreditation reviews

Required Qualifications:
  • Undergraduate degree or equivalent experience
  • 2 years of experience and solid knowledge of managed care related to health plan quality.
  • 2 years of solid, documented experience in successfully preparing and submitting NCQA Health Plan accreditation surveys
  • 2 years of experience in quality improvement including a high level of expertise of quantitative and qualitative analysis (e.g. PDSA, Six Sigma)
  • Excellent time management and prioritization skills
  • Strong oral and written communication skills
  • Proficiency in Microsoft basic with Excel or Access, Word Intermediate with Word and PowerPoint
  • Strong interpersonal skills
Preferred Qualifications:
  • Bachelor’s degree in healthcare related field
  • CPHQ or other quality designation preferred
  • Familiar with Medicaid regulatory requirements
  • Familiar with NCQA MHC and LTSS Distinction Modules
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.
Job Keywords: NCQA, Accreditations, Analysis, Audits, Accreditation Surveys, Surveys, NCQA Accreditation Surveys