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Senior Quality Nurse

4 weeks ago

Albuquerque, United States Optum Full time

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 (CQC) 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 be provider facing and participate in quality improvement initiatives, attend monthly or joint operating committee meetings, and develop recommendations for quality improvement. This position is responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship.

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

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.

Required Qualifications:

  • Registered Nurse within NM and/or a compact state. In lieu of RN license, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
  • 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 review clinical data and provide recommendations for improvement
  • Valid NM Drivers license and ability to travel 75% locally

Preferred Qualifications:

  • 2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
  • 2+ years of data analysis and/or quality chart review and abstraction
  • Billing and CPT coding experience
  • Medicare and/or Managed Care experience

Physical & Mental Requirements:

  • Ability to lift up to 10 pounds
  • Ability to push or pull heavy objects
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery Ability to properly drive and operate a vehicle
  • Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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.


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.

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