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UnitedHealth Group

HEDIS RN Sr. Clinical Quality Consultant - Quality Improvement - San Antonio, TX

UnitedHealth Group - San Antonio, TX

Position Description There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) The Sr. Clinical Quality Consultant will drive consistency, efficient processes and share best practices - in a collaborative effort with the providers - designed to facilitate a minimum 4 STAR rating. The CQC will drive quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for assigned markets. This position will work collaboratively with each regional / market team and their leadership in a matrix relationship. This position serves 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 and implement market business plans to motivate providers 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 go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional / Market operations Assist in developing of training and analytical materials for Stars and HEDIS Lead Weekly, Monthly, Bi-monthly, Quarterly and / or Annual Business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership Analyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies 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 Serve as team lead for the group of clinical quality consultants in the market Required Qualifications:Undergraduate degree or equivalent experienceCurrent unrestricted Registered Nurse (RN) license in the applicable state of employment3 years of HEDIS / Stars experience5 years associated business experience with health care industryProfessional experience persuading changes in behaviorStrong knowledge of the Medicare market, products and competitorsKnowledge base of clinical standards of care, preventative health, and Star measuresExperience in managed care working with network and provider relationsStrong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)Microsoft Office specialist with exceptional attention to detailPreferred Qualifications:Strong communication and presentation skillsStrong relationship building skills with clinical and non-clinical personnelDemonstrated ability to interact with medical staff, peers, and internal company staff at all levelsAbility to solve process problems crossing multiple functional areas and business unitsStrong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of actionGood business acumen, especially as it relates to MedicareMedical/clinical background highly desirableUndergraduate degree preferred, post graduate degree highly preferredPhysical & Mental Requirements: Ability to lift up to 10 poundsAbility to sit for extended periods of timeAbility to stand for extended periods of timeAbility to use fine motor skills to operate office equipment and / or machinery Ability to receive and comprehend instructions verbally and / or in writingAbility to use logical reasoning for simple and complex problem solvingCareers 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 90,000 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: RN, Clinical, Quality Consultant, Improvement, San Antonio, TX, Texas

14 days 21 hours ago

UnitedHealth Group


HEDIS RN Sr. Clinical Quality Consultant - Quality Improvement - San Antonio, TX UnitedHealth Group - San Antonio, TX, United States


Location: San Antonio, TX

Company Profile:
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term