Clinical Quality Analyst RN - Clinical Practice...

Remote, USA Full-time Posted 2025-11-24

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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. The Clinical Quality Analyst RN - Clinical Practice Consultant (CPC) is responsible for coordination of programs aimed toward clinical quality improvement and working with the providers to develop clinically oriented and community-based partnerships in order to increase quality scores based on state-specific quality measures. The CPC will work closely with the quality manager to coordinate an interdisciplinary approach to increased provider performance and member adherence to identified preventive and chronic condition screenings and tests. Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level; and monitoring, measuring and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives. In this role, the CPC will both assist contracted providers with meeting quality goals, as well as assisting the quality manager with the development of member facing programs while performing member outreach in the form of telephone, mailed and coordination of clinic days upon request. The goal of the quality team is continuous quality improvement using approved clinical practice guidelines, HEDIS, STARs, CMS, NCQA and other tools. Position reports to the Quality Leadership of the Health Plan. This is a hybrid, field position with a home - based office. If you are located in or within commutable driving distance to Albuquerque, NM and Las Cruces, NM, you will have the flexibility to work remotely* as you take on some tough challenges. 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: <ul> <li style="font-family: Tahoma;">Registered Nurse with active, unrestricted license in the state of residence</li> <li style="font-family: Tahoma;">3+ years of service delivery system or managed care setting experience</li> <li style="font-family: Tahoma;">2+ years of quality improvement experience, or other relevant quality experience</li> <li style="font-family: Tahoma;">Experience working in Medicaid in the Managed Care setting</li> <li style="font-family: Tahoma;">HEDIS / Medicare / STARS/ NCQA experience</li> <li style="font-family: Tahoma;">Working knowledge of EPSDT and the requirements for EPSDT</li> <li style="font-family: Tahoma;">Demonstrated ability in potentially assisting providers in contacting members in an effort to close identified gaps in care</li> <li style="font-family: Tahoma;">Demonstrated ability to travel locally to provider offices up to 75%25 of the time</li> <li style="font-family: Tahoma;">Demonstrated ability to present to provider groups</li> </ul> Preferred Qualifications: <ul> <li style="font-family: Tahoma;">BSN or bachelor’s degree in nursing, healthcare or related field</li> <li style="font-family: Tahoma;">Pediatric nursing experience preferable both inpatient and outpatient settings</li> <li style="font-family: Tahoma;">Health care and insurance industry experience, including regulatory and compliance</li> <li style="font-family: Tahoma;">Experience with utilizing and comparing past data trends and investigating data nuances - including CPT coding and Claims analysis</li> <li style="font-family: Tahoma;">Experience with wellness quality metrics</li> <li style="font-family: Tahoma;">Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry</li> <li style="font-family: Tahoma;">Demonstrated ability to present data and create Power Point Presentations around quality metric to provider and other groups outside the Health Plan</li> <li style="font-family: Tahoma;">Reside in Albuquerque or Las Cruces, NM areas</li> </ul> *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Clinical Quality Analyst RN - Clinical Practice...

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