Clinical Quality Analyst Stars Network Performance Specialist - Palm Beach- FL

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

The Clinical Quality Analyst (Stars Network Performance Specialist) works to improve quality and recommend process improvements. The Stars Network Performance Specialist assists the Stars Network Performance Team, Revenue Cycle Management (RCM) team and the Network Management Services (NMS) team in support of comprehensive business operations to increase Star rating goals. Primary duties include physician Stars education and acting as a liaison between Plan and provider as it relates to Stars. Under general direction, the Stars Network Performance Specialist is responsible for assisting in the daily operations of the Stars Network Department with all duties including, but not limited to, the responsibilities outlined below. This role will require daily travel to providers' offices in Broward and Miami / Dade counties.

Primary Responsibilities:
  • Perform group and individual training session according to the CMS Stars technical specs
  • Analyze provider Stars Non-Compliant List, Scorecards and other Stars reports to identify areas with opportunity
  • Accountable for the process of the provider to reach Star rating goals
  • Accountable for meeting monthly provider visit goal
  • Liaison between provider and health plan to achieve provider, group and plan rating
  • Share/educate provider on HEDIS tools and resources
  • Review / recommend provider STARS / HEDIS coding practices for optimal outcomes
  • Analyze work processes and identify areas where procedures and quality could be improved
  • Audits medical records to assure proper coding of submitted claims, and analyze provider gaps
  • Educates providers on proper documentation & coding for HEDIS compliance
  • Works closely with other departments (Finance, NMS and RCM) on provider progress / challenges
  • Flexibility in performance of work assigned in order to meet goals
  • Conduct Chart reviews, as needed

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

This position will work in office and the incumbent will report to the Miami, FL office when not traveling in the field. There is approximately 75% travel.

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:
  • Undergraduate degree or 2+ years of experience working in managed care in a quality environment
  • 2+ years of experience developing and implementing performance improvement projects or using data to develop intervention strategies to improve outcomes
  • 2+ years of managed care experience
  • Experience related to quality improvement / performance outcomes such as: HEDIS, STARS, NCQA and CAHPS / HOS
  • Intermediate experience with MS Office including Word, Excel, Outlook, and PowerPoint
  • Intermediate level skills interpreting data and making process improvement recommendations after data analysis
  • Experience collecting, analyzing and presenting data
  • Excellent verbal and written communication skills
  • Access to reliable transportation
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:
  • Experience in large, multi-function and cross geographic organizations
  • Bilingual (English and Spanish)
  • Coding and medical record abstraction experience
  • Strong organizational skills and ability to work both independently and with teams
  • Ability to evaluate medical records with attention to detail
  • Ability to use databases and prepare reports as needed
  • Ability to organize and coordinate group meetings

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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)

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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment 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: Quality Analyst, Clinical Quality Analyst, Analyst, Project Manager, Project Management, Analysis, Data Analysis, UnitedHealth Group, UHG, UHC Miami, Miami, FL, Florida