20 days old

Sr Clinical Quality Nurse - 920021

Houston, TX 77002
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  • Job Code
    920021

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 lifes best work.(sm)
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"WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patients health. WellMeds proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optumdivision under the greater UnitedHealth Group umbrella.
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"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 networks quality performance.
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Primary Responsibilities:

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  • 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
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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 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
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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 and large group performance and market performance as requested by or required by Quality or Regional leadership
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  • 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
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  • Assist in developing of training and analytical materials for Stars and HEDIS
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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, focus communications and efforts accordingly
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  • Develop solution-based, user friendly initiatives to support practice success
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  • Performs all other related duties as assigned
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The office is located near W Loop South, Houston, TX 77027

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This position has significant local and non-localtravel required as determined by the business supporting clinics and doctors offices throughout Houston Texas area

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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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RequiredQualifications:

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  • Registered Nurse (within the states in which service is being delivered)
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  • 4 + years of healthcare experience, including experience in a managed care setting
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  • 2 + years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
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  • 2 + years of experience in provider facing interactions, including provider education
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  • 2 + years of experience with data analysis and/or quality chart reviews. Must be able to review data and provide recommendations for improvement
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  • 25% local travel required, with occasional overnight travel
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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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  • Billing and CPT coding experience
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  • Clinical data abstraction experience
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  • Adaptable to change
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  • Good business acumen, especially as it relates to Medicare
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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 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 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.

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Job Keywords:WellMed, Healthcare, Bilingual, Registered Nurse, RN, Clinical Educator, Quality Training Lead, HEDIS/STAR, Consultant, Houston, Texas, TX

Posted: 2021-03-26 Expires: 2021-04-25

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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Sr Clinical Quality Nurse - 920021

UnitedHealth Group
Houston, TX 77002

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