25 days old

RN Clinical Quality Consultant Corpus Christi TX - 909221

Corpus Christi, TX 78401
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  • Job Code
    909221
  • 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 achieveyour life's best work. (sm)

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The 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 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 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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Youll 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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This position will be office based in Corpus Christi Texaswhen not traveling in the field 75% of the time to provider offices in the Corpus Christi and surrounding areas.

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Required Qualifications:

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  • Registered Nurse with Undergraduate degree or equivalent experience
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  • 1 years of HEDIS/Stars experience
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  • 3+ years associated business experience with health care industry
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  • Professional experience persuading changes in behavior
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  • Strong knowledge of the Medicare market, products and competitors
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  • Knowledge base of clinical standards of care, preventative health, and Star measures
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  • Experience in managed care working with network and provider relations
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  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
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  • Microsoft Office specialist with exceptional attention to detail
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  • You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Strong communication and presentation skills
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  • Strong relationship building skills with clinical and non-clinical personnel
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  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
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  • Ability to solve process problems crossing multiple functional areas and business units
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  • Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
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  • Good business acumen, especially as it relates to Medicare
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  • Medical/clinical background highly desirable
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  • Undergraduate degree preferred, post graduate degree
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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 380,000+ 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 doyour life's best work.(sm)

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"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.

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

Jobs Rated Reports for Registered Nurse

Posted: 2021-01-30 Expires: 2021-03-01

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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RN Clinical Quality Consultant Corpus Christi TX - 909221

UnitedHealth Group
Corpus Christi, TX 78401

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