Clinical Quality Nurse Specialist

3 days ago


Indianapolis, Indiana, United States UnitedHealth Group Full time
Senior Clinical Quality RN Opportunity

We are seeking a highly skilled and experienced Senior Clinical Quality RN to join our team at UnitedHealth Group. As a key member of our quality improvement team, you will play a critical role in driving consistency, efficient processes, and sharing best practices to facilitate a minimum 4 STAR quality performance.

Key Responsibilities:
  • 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
  • Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
  • 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
  • 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
  • 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
Requirements:
  • Active, Unrestricted RN License for Indiana
  • 4+ years of healthcare experience, including experience in a managed care setting
  • 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
  • 2+ years of experience in provider facing interactions, including provider education
  • 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review data and provide recommendations for improvement
  • Billing and CPT coding experience
  • Clinical data abstraction experience
  • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
  • Medicare experience
  • 25% local travel with occasional overnight travel

We are 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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