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Job Information

UnitedHealth Group Sr. Consultant - HEDIS Quality Technical SME - Remote in Plymouth, Minnesota

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Analyze, review, and trend complex healthcare data

  • Support short and long term operational/strategic business activities through analysis

  • Develop recommended business solutions through research and analysis of data and business process and implement when appropriate

  • Self-starter that demonstrates accountability for all assignments

  • Assess and interpret customer needs and requirements

  • Identify solutions to non-standard requests and problems

  • Solve moderately complex problems and/or conduct moderately complex analyses

  • Work with minimal guidance; seek guidance on only the most complex tasks

  • Translate concepts into practice

  • Provide explanations and information to others on difficult issues

  • Coach, provide feedback, and guide others

  • Act as a resource for others with less experience

  • Technical skill is required as this position is a mix of business and technical skills

  • Write clearly composed documentation for business requirements documentation as well as information that will be distributed to auditors

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:

  • Bachelor’s degree or equivalent work experience

  • 3+ years of experience with healthcare claims analysis

  • 3+ years of experience; skilled in reading and writing moderate to complex SQL commands and accurately assessing results

  • Experience with analyzing HEDIS metrics or Functional SME for HEDIS reporting

  • Experience researching conflicting and/or inaccurate data

  • Ability to travel up to 25% annually to USA domestic locations

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Experience with HEDIS vendor software or experience with HEDIS reporting using other tools

  • Experience gathering requirements from the client/business and documenting

  • Experience with process improvement, workflow, benchmarking and / or evaluation of business processes

  • Project Management experience

  • Working knowledge of relational databases, database structures

  • SSIS ETL development

  • Intermediate level of proficiency with PC based software programs and automated database management systems (Excel, Access, PowerPoint)

  • Currently residing in one of the following locations: Colorado Springs, CO, Dallas, TX, Hartford, CT, Pittsburgh, PA, Boulder, CO, Houston, TX, Nashville, TN, Tampa, FL, Eden Prairie, MN, Phoenix, AZ, St. Louis, MO

Careers with Optum . Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut, Nevada, or New York City Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada/New York City residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

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.

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