Freelance, Temporary, Full-Time
Eden Prairie, MN – Telecommute
Clinical Quality Analyst
Eden Prairie, Minnesota
Information Technology – Business Analyst
Adecco is currently assisting a local client in their search to fill Clinical Quality Analyst- Remote!
Clinical Quality Analyst – Telecommute
Core business hours (8-5 PM CST)
The Clinical Quality Analyst completes independent, subjective assessments of member calls and cases in accordance with the Optum s policies and external customer and regulatory standards. This will ensure adherence to departmental and regulatory data integrity standards and requirements including contractual obligations with State and Federal agencies and accreditation standards.
The primary responsibilities of the Clinical Quality Analyst are to support the Centralized Audit Team through the random selection of calls and cases. The quality analyst evaluates the effectiveness of the staff who engages members while managing various clinical programs end to end and captures the value delivered to our customers through the use and application of consumer centric quality audit tools.
The Centralized Audit Team provides quality oversight of the frontline staff and is comprised of quality analysts who conduct monthly evaluations of the calls and cases managed by the staff to ensure that client service levels are met or exceeded. The quality analyst is responsible to provide actionable feedback on each audit completed and this feedback may be used by site managers to help coach their staff in areas where there are opportunities for improvement.
Independently use discretion and clinical knowledge to evaluate subjective documentation of member records and call engagements to assess performance of clinical skills and customer service.
Applies advanced knowledge to conduct multispecialty subjective assessments to evaluate the skills and services provided. Multispecialty programs may include but are not limited to: Case Management, Disease Management, Health Care Decision Support and other lines of business as deemed appropriate.
Consults with Manager or Medical Directors to calibrate on subjective assessments to ensure consistency of feedback related to complex, high risk cases.
Assists Optum employees to stay ahead of changing information while improving the quality and effectiveness of agent and consumer engagement.
The Clinical Quality Analyst will highlight key findings to share with site managers for coaching purposes.
Ensure that process and procedural changes are reflected in staff members documentation such as job aids, policies and standard operating procedures.
Must reference all available customer specific details and requirements when evaluating calls and cases to ensure high quality customer service.
What skills/attributes are a must have?
Current, unrestricted RN license in the State where they reside
3+ years clinical experience in a hospital, acute care, home health / hospice, direct care or case management
1+ year in a Clinical Contact Center environment required. Proven customer service skills and experience.
Ability to make independent decisions to complete subjective assessments of nursing skills
Ability to interpret subjective subject matter across multispecialty clinical case reviews
Multispecialty programs include Maternity, Oncology, Treatment Decision Support, Case Management, Disease Management, RN Advocacy and Complex Medical Conditions across all lines of business; Medicaid, Medicare, Duals, and Commercial
Ability to communicate technical information to non-technical personnel
Ability to communicate in person, by phone, or via e-mail in a professional and friendly manner
Ability to work and interact with professionals as part of an interdisciplinary team
Self-motivated, flexible person who can flourish in an office setting with colleagues as well as in a self-structured indepe…
Medical & Health , Nursing , Analyst
Eden Prairie, MN