Senior Clinical Quality Analyst - CA Remote - Remote Eligible

Clinical Quality Oversight

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.

Responsible for providing clinical quality oversight of the TERM provider panel, including appointing providers that meet the referral needs of Child and Family Well-Being referred clients, conducting quality review of treatment plans completed by TERM panel providers, investigation and resolution of complaints regarding TERM providers, and collaborating with leadership on improvement opportunities to best meet the needs of TERM clients and stakeholders.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. MUST HAVE AN INDEPENDENT CA LICENSE

Primary Responsibilities:

• Completes clinical quality review of treatment plans for CFWB clients to ensure consistency of treatment goals to identified referral concerns, appropriateness of therapeutic intervention, sufficient documentation of progress towards discharge, and any other indicators directed by the County
• Provides quality review feedback and recommendations for improvement to assist providers in meeting professional standards and TERM requirements. For work products that do not meet established minimum standards, effectively collaborates with the provider to address the identified concerns which may involve requesting the provider submit an update to their original submission. Notifies the CFWB referral source of any report delays resulting from the quality review process. Adheres to established turn-around times for the quality review process
• Conducts review of therapy referral forms from CFWB to ensure completeness of documentation and that clinical needs are clearly identified and consistent with CFWB referral policies. Forwards any identified concerns to CFWB designated contacts(s). Uses the designated provider search database to identify providers that match the clinical needs of the referral, conducts outreach and assigns referrals to providers that most closely meet the clinical needs. If unable to successfully locate a provider willing to accept the referral within the specified turn-around time, communicates the status and any identified options to CFWB designated contact(s). Assists with preparing a weekly referral summary report for CFWB designated contacts
• When the need for an off-panel provider is identified, locates and clinically vets prospective off-panel providers; proactively provides education on TERM requirements
• Supports TERM provider recruitment and retention initiatives
• Investigates complaints and quality of care issues related to TERM providers and participates in the peer review resolution process
• Documents provider searches, quality review and complaint investigation activities according to TERM clinical record keeping standards; adheres to all established turn-around time requirements for these processes
• Runs all assigned data entry validation reports in accordance with established policies and procedures to assist with data integrity; assists with any additional reporting and report validation as assigned
• Conducts site monitoring of TERM group psychotherapy as assigned, in accordance with established TERM group psychotherapy standards
• Conducts review of TERM panel provider/intern application and re-credentialing application materials to ensure clinical specialty requirements are met and any applicable writing samples meet established criteria
• Assists with developing and maintaining TERM portion of the new Provider Orientation; conducts documentation orientations with new providers to educate new providers on TERM policies and requirements
• Assists with TERM provider training as needed
• Assists with developing educational materials/resources for provider
• Assists with updating the TERM Provider Handbook and associated materials
• Contributes articles relevant to TERM provider practice to the provider newsletter
• Assists with updating written TERM processes
• Assists with developing and maintaining clinical standards relevant to quality oversight of treatment and evaluations for CFWB and juvenile justice involved populations
• Advises leadership on improvement opportunities and assists with developing or enhancing policies, procedures, processes, reporting and applications to best serve County customers and improve operational oversight
• Maintains positive working relationships with all TERM stakeholders
• Assists other clinical teams as requested
• Other duties as assigned

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:

• LMFT, LCSW, LPCC, or licensed Psychologist
• License must be current and unrestricted in the State of California
• Demonstrated clinical experience with a broad range of clinical populations and with provision of evidence-based clinical practices
• Proven excellent oral and written communication skills
• Proven excellent problem solving and organizational skills
• Proven solid computer skills, including proficiency in Microsoft office applications

Preferred Qualifications:

• Experience providing oversight or feedback to other clinical professionals
• Experience providing therapy services to CFWB clients

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). The salary for this role will range from $71,200 to $127,200 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 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. UnitedHealth Group is 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 is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.