Senior Clinical Quality Analyst - Remote

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.

About the role

The Clinical Quality Consultant leads quality improvement initiatives through data analysis, performance monitoring, and reporting. Partners with the entire clinical operations teams to support process improvement, regulatory compliance, project management, and performance initiatives that enhance operational effectiveness. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• Develop, analyze, and monitor quality, operational, and behavioral health metrics to identify trends, risks, and opportunities for improvement
• Support NCQA accreditation activities, government program requirements, contractual obligations, and other regulatory requirements
• Design, implement, and evaluate quality improvement initiatives, including HEDIS®, to drive measurable performance outcomes
• Translate quality findings into measurable goals, improvement strategies, and actionable recommendations
• Prepare and present reports, dashboards, executive summaries, and performance updates for leadership, customers, and external stakeholders
• Ensure data integrity and content accuracy through quality assurance review of monthly, quarterly, and annual customer reporting submissions
• Act as a secondary resource for member and provider complaint review and resolution, ensuring timely and compliant handling
• Provide project management, consultation, process improvement, and operational support to Utilization Management (UM), Care Management (CM), Care Coordination, Quality, and other Clinical Operations teams
• Partner with operational leaders to develop and implement solutions that support strategic priorities, operational effectiveness, compliance, quality performance, and member outcomes
• Conduct audits and reviews of clinical documentation, operational processes, and procedures to ensure compliance with organizational, contractual, accreditation, and regulatory requirements
• Assess operational performance, identify process gaps, and recommend workflow improvements that enhance efficiency, quality, and compliance
• Support cross-functional initiatives and regulatory readiness activities to ensure ongoing compliance and successful operational execution

Requirements

• 4+ years of experience in behavioral health direct service (mental health or substance use) or behavioral healthcare operations
• 2+ years of experience leading or supporting quality improvement, performance improvement, or process improvement initiatives
• Experience collecting, analyzing, interpreting, and presenting data to support decision-making and performance improvement
• Proven solid analytical, organizational, and communication skills
• Proven ability to manage multiple priorities and work collaboratively across teams

Preferred Qualifications

• Experience developing reports, dashboards, and performance summaries
• Experience with healthcare quality measures and programs, including HEDIS® and NCQA standards
• Experience supporting regulatory, accreditation, or contractual compliance requirements
• Experience with behavioral health quality and operational performance metrics
• Project management experience, including leading cross-functional initiatives and tracking deliverables

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Pay

The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.