Senior Clinical Quality Analyst - Remote| San Diego, California | Remote

Senior Quality Analyst

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.

Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Quality Analyst, you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements.

You will also review medical records and interface with clinicians to ensure that treatment being rendered is within the community standard of care and identify areas where care can be improved. You'll act as a voice for our members, guiding the development of comprehensive care plans that will help others live healthier lives.

We're looking for a self-motivated licensed behavioral healthcare professional with Quality Improvement (QI), accreditation and/or data analysis experience. In this position, you would analyze essential data and develop and implement QI initiatives. The Quality Improvement team is focused on improving the health of our members, enhancing our operational effectiveness and reinforcing brand and reputation for high-quality health plans. Join us and help guide our efforts to improve the patient experience and satisfy our health plan customers.

It takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment.

You'll enjoy the flexibility to work remotely from California.

Primary Responsibilities:

• Support behavioral health quality improvement activities, performance improvement projects, and annual program deliverables for California health plan customers
• Collect, analyze, and interpret clinical and operational data to identify trends, risks, and opportunities for improvement in quality performance and member experience
• Prepare reports, summaries, dashboards, and presentation materials for internal leadership, committees, and external customers
• Partner with health plan customers and internal stakeholders to monitor quality metrics, support corrective actions, and advance behavioral health quality initiatives
• Support compliance with California and national quality requirements, including applicable state and federal regulations and accreditation standards such as DMHC, NCQA, HEDIS, and URAC
• Conduct quality of care reviews and investigations related to enrollee grievances, identified quality concerns, and sentinel events, and document findings in accordance with established processes
• Assist in preparing audit-ready documentation and evidence for quality management reviews, audits, and accreditation activities
• Support quality management committees and work groups through agenda development, meeting materials, follow-up tracking, and documentation of key actions
• Review clinical documentation and collaborate with licensed clinicians and operations partners to promote compliance with documentation standards and community standards of care
• Contribute to behavioral health HEDIS and related performance improvement efforts by helping design, implement, and monitor interventions in partnership with customers and cross-functional teams

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:

• Current, unrestricted California behavioral health license (e.g., LMFT, LCSW, LPCC, Psychologist, or other independently licensed behavioral health clinician, as applicable)
• Current California residency
• 3+ years of professional experience in behavioral health, clinical quality, quality management, utilization management, case management, or a related healthcare function
• 1+ years of experience in a managed care, health plan, delegated entity, or behavioral health quality environment
• Experience using Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint, with the ability to create, edit, and present reports and documents
• Access to reliable high-speed internet and a home workspace suitable for remote work

Preferred Qualifications:

• Experience collecting, analyzing, and presenting clinical or quality performance data
• Experience supporting performance improvement projects or using data to inform intervention strategies and operational…