19 days old

Clinical Quality RN - 933787

Las Cruces, NM 88001
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  • Job Code
    933787
  • Jobs Rated
    122nd

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 lifes best work.(sm)

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The Clinical Quality RN 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 Clinical Quality RN will participate in quality improvement initiatives, 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.

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Primary Responsibilities:

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  • Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
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  • Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
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  • 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.
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  • Assist in developing of training and analytical materials for Stars and HEDIS
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  • Lead or participate and present in 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.
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  • Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
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  • Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes
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  • Focus communications and efforts accordingly
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  • Develop solution-based, user friendly initiatives to support practice success
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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.

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Required Qualifications:

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  • Registered Nurse (within the states in which service is being delivered) with undergraduate degree or (4 years equivalent experience above and beyond the required years of experience may be considered in lieu of undergraduate degree)
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  • 3+ years of experience within the health care industry to include quality of care measures
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  • Ability to travel locally up to 50 - 75 %, with occasional overnight travel
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  • Reliable transportation that will enable you to travel to client and /or patient sites within a designated area
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • Undergraduate degree or post graduate degree
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  • Billing and CPT coding experience
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  • Clinical data abstraction experience
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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)

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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.

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OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

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Job Keywords Quality RN, HEDIS, STARS, CMS, CPT, Clinical Documentation, El Paso, TX, Texas

Jobs Rated Reports for Registered Nurse

Posted: 2021-07-05 Expires: 2021-08-12

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.

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Clinical Quality RN - 933787

UnitedHealth Group
Las Cruces, NM 88001

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Registered Nurse
122nd2019 - Registered Nurse
Overall Rating: 122/199
Median Salary: $71,730

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Stress
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Growth
Good
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