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Senior Clinical Quality RN Consultant - Abilene, TX

Company: UnitedHealth Group
Location: San Angelo
Posted on: November 18, 2021

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)The Sr. Clinical Quality Consultant (CQC) will drive consistency, efficient processes and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 STAR quality performance.The Sr CQC will participate in quality improvement initiatives, attend monthly or joint operating committee meetings, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. This position may serve as the team lead for the clinical quality consultants in the assigned market and has responsibility for the network's quality performance.Primary Responsibilities:

  • Develop market business plans to motivate providers and large or complex group leadership to engage in improving Stars measures to be 4 STARS or higher
  • Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
  • Be the primary subject matter expert for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
  • Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider and large group performance and market performance as requested by or required by Quality or Regional leadership
  • Analyze and evaluate provider and large group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
  • Assist in developing of training and analytical materials for Stars and HEDIS
  • Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes, focus communications and efforts accordingly
  • Develop solution-based, user-friendly initiatives to support practice success
  • Performs all other related duties as assignedYou'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:
    • Registered Nurse (within the states in which service is being delivered)
    • 4+ years of healthcare experience, including experience in a managed care setting
    • 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
    • 2+ years of experience in provider facing interactions, including provider education
    • 2+ years of experience with data analysis and/or quality chart reviews. Ability to review data and provide recommendations for improvement
    • Solid knowledge of the Medicare market, products and competitors
    • Proven ability to influence providers to change behavior and drive improvement in quality performance
    • Experience in managed care working with network and provider relations
    • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
    • Ability to solve process problems crossing multiple functional areas and business units
    • Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
    • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Proficient in Excel
    • Excellent customer service skills
    • 25% local travel, with occasional overnight travel
    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliancePreferred Qualifications:
      • Undergraduate degree or Postgraduate degree
      • Billing and CPT coding experience
      • Clinical data abstraction experience
      • Adaptable to change
      • Good business acumen, especially as it relates to Medicare
      • Solid communication and presentation skillsPhysical & Mental Requirements:
        • Ability to lift up to 10 pounds
        • Ability to stand for extended periods of time
        • Ability to use fine motor skills to operate office equipment and/or machinery
        • Ability to properly drive and operate a vehicle
        • Ability to receive and comprehend instructions verbally and/or in writing
        • Ability to use logical reasoning for simple and complex problem solvingUnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: Registered Nurse, RN, Clinical Quality, Quality Nurse, HEDIS measures, STAR measures, Managed Care, Clinical Quality Consultant, Medicare, Data Analysis, Chart Review, Dallas, Midland, Odessa, San Angelo, Abilene, TX, Texas

Keywords: UnitedHealth Group, San Angelo , Senior Clinical Quality RN Consultant - Abilene, TX, Healthcare , San Angelo, Texas

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