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.
The Senior Clinical Quality Analyst supports the development and validation of clinical quality measures and healthcare analytics used within the United States healthcare system. This non‑clinical role applies formal clinical education and hands‑on patient care experience to ensure that quality measures, analytic outputs, and supporting documentation accurately reflect evidence‑based guidelines and real‑world clinical practice.
The role partners with clinical methodologists, product managers, engineering, and data science teams to provide clinical perspective across quality measurement, value‑based care analytics, and technology‑enabled solutions. Success in this position requires a strong understanding of U.S. clinical care delivery, as well as the ability to translate clinical concepts into clear, structured logic and documentation for technical and non‑clinical audiences.
Primary Responsibilities:
- Apply clinical knowledge and patient care experience to support the development, refinement, and maintenance of healthcare quality measures and analytic products used in value‑based care and quality programs
- Conduct targeted literature and clinical guideline review (e.g., clinical guidelines, professional society recommendations) to inform quality measure updates and clinical rationale
- Assist with developing and reviewing client‑facing documentation that explains the clinical rationale for quality measures, including how measures align with evidence‑based care
- Participate in physician consultant panel meetings with external physicians and internal teams to contribute clinical input on the maintenance and development of quality measures
- Review, validate, and contribute to diagnosis, procedure, and laboratory code sets. Collaborate with coding specialists and clinical stakeholders to ensure clinical appropriateness
- Provide clinical perspective to support interpretation of insights generated by analytic and AI‑enabled tools
- Leverage enterprise-approved AI tools to enhance productivity and innovation by streamlining workflows and automating repetitive tasks. Evaluate emerging trends to drive continuous improvement and strategic innovation.
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- Clinical professional with formal education in patient clinical care (4+ years) and hands‑on patient care experience, with education aligned to U.S. clinical care standards
- Experience working with healthcare analytics, reporting, or technology‑enabled solutions, including familiarity with how analytic or AI‑enabled tools are used to support clinical insights, quality improvement, or performance monitoring
- Clinical background is most important as well as some knowledge of coding (ICD10, CPT, LOINC, HCPCS)
- Good knowledge of the Microsoft platform
- Demonstrated understanding of the United States healthcare system, including care delivery workflows, documentation practices, and how clinical data is used for quality, utilization, or performance measurement
- Proficiency with Microsoft productivity tools (Word, Excel, PowerPoint, Outlook)
- Proven effective written and verbal communication skills, with the ability to explain clinical concepts clearly to non‑clinical team members
- Proven solid organizational skills and ability to manage multiple priorities concurrently
Preferred Qualifications:
- Experience working in Microsoft Teams
- Recent clinical experience, preferably with some experience in oncology (within the past 5 years)
- Experience supporting U.S. healthcare quality initiatives, quality measurement programs, utilization management, population health, or value‑based care analytics
- Familiarity with healthcare data and medical coding systems used in the U.S. (e.g., ICD‑10, CPT, HCPCS)
- Proven exposure to administrative claims data, clinical data, or analytic datasets used for reporting or performance measurement
- Proven comfort reviewing and validating clinical logic, definitions, assumptions, or documentation for accuracy, clarity, and alignment to real‑world care
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.