***Position is Hybrid serving the EAST VALLEY ***
(Time spent in the field, working from home and occasionally in the office for meetings or training)
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Sr. Clinical Quality Consultant RN 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.
If you are located in the East Valley (Chandler, Mesa, Tempe, Gilbert, Queen Creek) you will have the flexibility to work from home and in the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities:
- Develop business plans to motivate providers to improve STARS measure performance
- Provide analytical interpretation and STARS/HEDIS performance summaries to provider groups
- Be the subject matter expert for all STARS-related activities within their assigned territory working within a matrix relationship
- Participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider performance
- Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel to identify the most effective approaches and strategies to improve STARS measure performance
- Assist in developing STARS/HEDIS presentation materials for provider performance meetings
- Visit patient homes in the East Valley to close gaps in care.
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 AZ and/or a compact state)
- 4+ years of healthcare experience
- 2+ years of experience in provider-facing interactions
- Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
- Ability to travel locally 50%
- Driver's license and access to reliable transportation
Preferred Qualifications:
- 2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
- 2+ years of clinical data abstraction/quality chart review experience
- Billing and CPT coding experience
- Medicare and/or managed care experience
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
