Senior Clinical Quality RN - San Angelo, TX - San Angelo, TX - Clinical
Company: UnitedHealth Group
Location: San Angelo
Posted on: August 7, 2022
Job Description:
Senior Clinical Quality RN - San Angelo, TX - San Angelo, TXDo
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.-- ****Travel required in San Angelo, TX and
surrounding areas******* 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 assigned -- 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:
- 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
- Experience in managed care working with network and provider
relations
- Solid knowledge of the Medicare market, products and
competitors
- Experienced using Microsoft office applications, including
databases, word-processing, and excel spreadsheets. Proficient in
Excel
- Ability to travel locally up to 25% with occasional overnight
travel
- Full COVID-19 vaccination is an essential job function of this
role. Candidates located in states that mandate COVID-19 booster
doses must also comply with those state requirements. UnitedHealth
Group will adhere to all federal, state and local regulations as
well as all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance. Candidates must be able to perform all essential
job functions with or without reasonable accommodation Preferred
Qualifications:
- Undergraduate degree preferred, 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 skills
- Ability to review data and provide recommendations for
improvement
- Proven ability to influence providers to change behavior and
drive improvement in quality performance
- 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
- Excellent customer service skills Physical & Mental
Requirements:
- Ability to lift up to 10 pounds
- Ability to sit--for--extended periods of time
- 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
solving -- To protect the health and safety of our workforce,
patients and communities we serve, UnitedHealth Group and its
affiliate companies require all employees to disclose COVID-19
vaccination status prior to beginning employment. In addition, some
roles and locations require full COVID-19 vaccination, including
boosters, as an essential job function. UnitedHealth Group adheres
to all federal, state and local COVID-19 vaccination regulations as
well as all client COVID-19 vaccination requirements and will
obtain the necessary information from candidates prior to
employment to ensure compliance. Candidates must be able to perform
all essential job functions with or without reasonable
accommodation. Failure to meet the vaccination requirement may
result in rescission of an employment offer or termination of
employment. -- 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) WellMed was
founded in 1990 with a vision of being a physician-led company that
could change the face of healthcare delivery for seniors. Through
the WellMed Care Model, we specialize in helping our patients stay
healthy by providing the care they need from doctors who care about
them. We partner with multiple Medicare Advantage health plans in
Texas and Florida and look forward to continuing growth. *All
Telecommuters will be required to adhere to UnitedHealth Group's
Telecommuter Policy -- Diversity creates a healthier atmosphere:
OptumCare is an Equal Employment Opportunity/Affirmative Action
employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.
Keywords: UnitedHealth Group, San Angelo , Senior Clinical Quality RN - San Angelo, TX - San Angelo, TX - Clinical, Healthcare , San Angelo, Texas
Didn't find what you're looking for? Search again!
Loading more jobs...