Clinical Quality Analyst - Remote in VA Market Only

UnitedHealthcare; Richmond (VA); Remote; Full time

Job summary

A leading healthcare company is looking for a remote Quality Management Reviewer who will conduct reviews for HCBS waivers and work closely with providers to ensure compliance and improve care delivery. The role requires a degree in a health-related field and offers a flexible work environment while impacting the lives of many.

Benefits

Comprehensive benefits package

Equity stock purchase

401(k) contributions

Qualifications

• 2+ years of direct experience.
• 1+ years of experience with MS Office.

Responsibilities

• Conduct quarterly onsite quality management reviews for HCBS waivers.
• Provide ongoing education and support to providers on QMR process.
• Collaborate with Provider Advocates and maintain reporting.

Skills

Experience with MS Office

Education

4-year or higher degree in a health-related field

Job description

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.

• While this is a Remote opportunity in the state of VA, the role does require travel for a minimum of 1 week per quarter.

If you reside within the state of VA, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities

• Conduct quarterly onsite quality management reviews for the HCBS waivers and programs as assigned by our state partner.
• Determine if services were delivered in accordance with the service plan.
• Conduct follow-up reviews as needed based on results from initial reviews (may be onsite or virtual).
• Discuss QMR details with providers.
• Assist providers with development of action plans.
• Provide ongoing education and support to providers and internally on the QMR process and waiver services processes. Maintain and submit quarterly reporting for the state partner.
• Collaborate with Provider Advocates, Networking, and the Service Integrity Unit as needed.
• Engage in ongoing collaboration and training with the state partner.
• Remain up to date with provider manuals and state regulations.

Required Qualifications

• 4-year or higher degree in a health-related field (e.g., psychology, counseling, etc.) and 2+ years of direct experience.
• 1+ years of experience with MS Office, including Word, Excel, and Outlook.

Preferred Qualifications

• Experience working in team-based care.
• Experience working with Virginia Medicaid.
• Experience working with long-term care individuals.
• Background in Managed Care.
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The hourly range for this role is $28.61 to $56.06 per hour, based on full-time employment. Pay is determined by factors such as local labor markets, education, work experience, and certifications. UnitedHealth Group complies with all applicable minimum wage laws. In addition to salary, we offer benefits including a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contributions (eligibility requirements apply).

Our mission at UnitedHealth Group is to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and promoting equitable care, especially for marginalized groups and lower-income populations.

UnitedHealth Group is an Equal Employment Opportunity employer. Qualified applicants will receive consideration regardless of race, gender, sexuality, age, disability, or other protected characteristics. We are also a drug-free workplace; candidates must pass a drug test prior to employment.