Senior clinical quality analyst

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.

Responsible for ensuring the development and implementation of the annual accreditation preparedness plan that meets or exceeds required compliance with URAC, ACHC and NABP standards across pharmacy and wholesale locations. Work with Pharmacy Operations, distribution and licensing to develop an ongoing readiness and quality improvement strategy to ensure ongoing compliance.

This position contributes to the departmental objectives of maintaining operational conformance with established quality standards, regulatory, accreditation and contractual requirements, streamlining business processes, and using continuous quality improvement methodologies to identify opportunities for improvement.

This position involves the use of Personal Health Information (PHI).

This position is full time Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm. It may be necessary, given the business need, to work occasional overtime.

This will be on the job training and the hours will be during normal business hours.

Primary Responsibilities

• Support on-line ACHC applications, maintenance attestations, and organizational change notifications.
• Identify and coordinate with business leads and Subject Matter Experts to obtain required evidence, evaluate for ACHC completeness.
• Overcome challenges to obtaining needed information, prepare for ACHC surveys, including readiness reviews, mock surveys, operational walkthroughs, record sampling, document validation, and staff preparation.
• Convert ACHC standards into standards-to-evidence trackers, and develop and manage ACHC readiness plans, project timelines, gap analyses, policy assessments, dashboards, and other tools supporting ongoing compliance.
• Proactively identify quality risks, communicate potential barriers to the functional areas; assist functional areas with the development of action plans to address risks, gaps, root causes, and/or barriers.
• Connect with leaders from business segments and staff to ensure continuous accreditation compliance.
• Develop and maintain training modules and staff education for ACHC-accredited areas.
• Act as Subject Matter Expert (SME) in the development and documentation of Quality Improvement Projects (QIPs), Corrective Action Plans (CAPs) and Quality Improvement Activities (QIAs) for ACHC and other accrediting bodies.
• Prepare, facilitate and attend ACHC onsite/virtual accreditation surveys and any onsite monitoring visits, and coordinate responses to findings and plans of correction.
• Interpret and operationalize ACHC standards and applicable requirements and communicate standard updates and their impact to the business.
• Support other accreditation onsite audits as applicable (URAC, NABP).
• Educate, motivate, and/or influence others (e.g., leadership, other stakeholders, including those for whom there is no direct line of authority) to understand the overall scope, overcome potential barriers, and engage in and commit to the process.

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:

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years of experience in quality auditing, healthcare compliance, pharmacy operations, OR pharmacy fulfillment experience
• Proficiency in Microsoft Excel, Word, and PowerPoint
• May require travel by plane or car, with minimal notice, based on accrediting agency policies.
• Ability to travel up to 25% of the time - domestic
• Requires a valid driver's license.
• Ability to work full time Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8am - 5pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Experience in a managed care setting with responsibility for quality management and / OR regulatory compliance
• Project management experience
• Experience interpreting federal and state regulatory OR accreditation requirements
• Certified Professional in Healthcare Quality (CPHQ) credential OR other auditor program
• Experience collaborating with external clients and stakeholders.

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Strong interpersonal skills, including positive assertiveness, professional communication, relationship building, and effective written and verbal communication

*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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.