Remote HEDIS Quality Improvement Consultant (ID)

UnitedHealth Group; Houston (TX); Remote; USD 33,000 - 59,000; Full time

Job summary

UnitedHealth Group is seeking a Clinical Practice Consultant to develop clinically oriented provider and community partnerships and drive quality improvement across HEDIS and state measures. The role involves ongoing management of provider practice quality measures, documentation review, and performance reporting.

The position supports remote work with Idaho-based flexibility and requires substantial travel to physician offices as needed.

Qualifications

• 3+ years of clinical experience in a physician practice, outpatient facility or a FQHC.
• 2+ years of quality improvement experience.
• 2+ years of Medicare/Medicaid experience.
• Proficiency in software applications including Microsoft Word, Excel, and PowerPoint.

Responsibilities

• Ongoing management of provider practice and community education on HEDIS, NCQA, and state quality measures.
• Develop action plans with provider practices to drive quality improvement.
• Educate providers and staff on documentation, coding, billing practices, CMS metric specifications, and pay-for-performance criteria.
• Analyze and report key metrics to help providers meet quality standards and contractual requirements.
• Serve as SME for Medicaid/Medicare HEDIS/CMS measures and liaise with vendors to improve measure rates.
• Identify patient care opportunities and coordinate member appointments and care.
• Conduct onsite evaluations via medical record audits to ensure proper coding and billing practices.

Skills

Clinical experience

Quality improvement

Medicare/Medicaid experience

MS Office

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

UnitedHealth Group is seeking a Clinical Practice Consultant to develop clinically oriented provider and community partnerships and drive quality improvement across HEDIS and state measures. The role involves ongoing management of provider practice quality measures, documentation review, and performance reporting.

The position supports remote work with Idaho-based flexibility and requires substantial travel to physician offices as needed.