Clinical Quality Nurse Specialist

5 days ago


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

We are seeking a highly skilled Senior Clinical Quality RN to drive consistency, efficient processes, and share best practices in a collaborative effort with providers and large or complex groups. The successful candidate will facilitate a minimum 4 STAR quality performance and participate in quality improvement initiatives.

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.
  • Assist in developing of training and analytical materials for Stars and HEDIS.
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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. 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.



  • Indianapolis, Indiana, United States Clinical Architecture Full time

    About the RoleClinical Architecture is seeking a skilled Client Support Specialist to join our team in Carmel, IN. As a key member of our support team, you will engage with customers and clients to provide exceptional support and enhance their experience.This role requires a strong ability to learn and understand our software and its capabilities, as well as...


  • Indianapolis, Indiana, United States Community Health Network Full time

    Job Title:Clinical Nurse Specialist InternJob Summary:We are seeking a highly motivated and dedicated Clinical Nurse Specialist Intern to join our team in Specialty Maternity/OB Services at Community East and South. As a Clinical Nurse Specialist Intern, you will have the opportunity to learn and grow in a dynamic and supportive environment, working closely...


  • Indianapolis, Indiana, United States IQVIA Full time

    Job Title: Clinical Nurse SpecialistWe are seeking a skilled Clinical Nurse Specialist to join our team at IQVIA. As a Clinical Nurse Specialist, you will have the opportunity to utilize your clinical nursing expertise in a new and exciting way, working with medical device technology to improve patient outcomes.Responsibilities:Collecting medical devices in...


  • Indianapolis, Indiana, United States UnitedHealth Group Full time

    Senior Clinical Quality RN OpportunityWe 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...


  • Indianapolis, Indiana, United States UnitedHealth Group Full time

    Senior Clinical Quality RN Job DescriptionWe 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...


  • Indianapolis, Indiana, United States Community Health Network Full time

    Job SummaryWe are seeking a Clinical Nurse Specialist Intern to join our team in Specialty Maternity/OB Services at Community East and South. As a Clinical Nurse Specialist Intern, you will provide expert, integrated supportive consultation services for the promotion of safe, cost-effective, quality patient care across the health care continuum.Key...


  • Indianapolis, Indiana, United States Parkview North Hospital Full time

    Job SummaryThe Quality/Accreditation Specialist plays a crucial role in supporting Parkview North Hospital's mission and vision by assisting with the development, implementation, and evaluation of patient safety and quality improvement projects.Key ResponsibilitiesAssist in researching and analyzing quality improvement projects to identify areas for...


  • Indianapolis, Indiana, United States IQVIA Full time

    Job SummaryWe are seeking a skilled Clinical Nurse Specialist to join our team at IQVIA. As a key member of our team, you will have the opportunity to utilize your clinical nursing expertise in a new and exciting way, collaborating with healthcare professionals and advocating for patient well-being through medical device technology.Key ResponsibilitiesAssist...

  • Clinical Specialist

    2 weeks ago


    Indianapolis, Indiana, United States Central Indiana Orthopedics Full time

    Job SummaryWe are seeking a highly skilled and dedicated Clinical Specialist to join our team at Central Indiana Orthopedics. As a key member of our clinical staff, you will play a vital role in providing exceptional patient care and supporting our physicians in delivering high-quality medical services.ResponsibilitiesAssist physicians with clinical and...


  • Indianapolis, Indiana, United States Community Health Network Full time

    Job Title: Clinical Nurse Specialist - Maternity/OB ServicesCommunity Health Network is seeking a highly skilled Clinical Nurse Specialist to join our team in Specialty Maternity/OB Services at Community East and South.About the Role:The Clinical Nurse Specialist will demonstrate leadership abilities through participation in group processes, program...


  • Indianapolis, Indiana, United States Adtalem Global Education Full time

    Job Title: Clinical Coordination SpecialistAt Adtalem Global Education, we are committed to providing exceptional education and training to our students. We are seeking a highly motivated and organized Clinical Coordination Specialist to join our team.Job Summary:The Clinical Coordination Specialist will be responsible for coordinating student clinical...

  • Clinical Specialist

    6 days ago


    Indianapolis, Indiana, United States OrthoAlliance Full time

    Job SummaryWe are seeking a highly skilled and dedicated Clinical Specialist to join our team at OrthoAlliance. As a key member of our clinical staff, you will be responsible for providing exceptional patient care and support to our patients and physicians.Key ResponsibilitiesAssist physicians with clinical and administrative duties, including rooming...


  • Indianapolis, Indiana, United States Community Health Network Full time

    Job SummaryWe are seeking a highly skilled Clinical Nurse Specialist to join our team in Specialty Maternity/OB Services at Community East and South. As a CNS, you will demonstrate leadership abilities and conduct value analysis to improve clinical programming. You will also act as an expert resource to care management and articulate nurse-sensitive...


  • Indianapolis, Indiana, United States Indiana Hemophilia and Thrombosis Center Full time

    About the Indiana Hemophilia & Thrombosis CenterWe are a not-for-profit program based in Indianapolis, dedicated to providing comprehensive services and holistic care to patients with bleeding, clotting, and other hematologic disorders.Job SummaryWe are seeking a Research Nurse Specialist to assist with the execution of research projects under the direction...


  • Indianapolis, Indiana, United States Trinity Health Full time

    Job SummaryThe Quality Improvement Specialist plays a vital role in enhancing the quality of care at Trinity Health. This position is responsible for coordinating and assisting with key quality improvement activities and projects, ensuring the delivery of high-quality patient care.Key ResponsibilitiesCollaborate with healthcare providers to gather data and...


  • Indianapolis, Indiana, United States TRIGO Global Quality Solutions Full time

    Job Title: Quality InspectorTRIGO Global Quality Solutions is seeking a Quality Inspector to join our team in Marion, OH. As a Quality Inspector, you will be responsible for ensuring the quality of products and services in a fast-paced manufacturing environment.Key Responsibilities:Inspect manufactured parts or products for defects and ensure they meet...


  • Indianapolis, Indiana, United States TRIGO Global Quality Solutions Full time

    Job Title: Quality InspectorTRIGO Global Quality Solutions is seeking a Quality Inspector to join our team in Marion, OH.About the Role:We are looking for a detail-oriented and organized individual to provide quality services and support for all missions assigned to a manufacturing or warehouse site. The successful candidate will ensure a healthy and safe...


  • Indianapolis, Indiana, United States SNI Companies Full time

    Job Title: Quality Assurance SpecialistAt SNI Companies, we are seeking a highly skilled Quality Assurance Specialist to join our team. As a Quality Assurance Specialist, you will play a critical role in ensuring the quality of our services and products.Key Responsibilities:Conduct quality audits and assessments to identify areas for improvementDevelop and...

  • Nurse: ICU Specialist

    2 weeks ago


    Indianapolis, Indiana, United States Jackson Nurse Professionals Full time

    Travel ICU Nurse Job OpportunityWe're seeking a skilled Registered Nurse with experience in Intensive Care Unit settings to join our team at Jackson Nurse Professionals. As a travel nurse, you'll have the opportunity to work in a dynamic and supportive environment, providing high-quality patient care and collaborating with a talented team of healthcare...

  • Nurse Specialist

    3 weeks ago


    Indianapolis, Indiana, United States Jackson Nurse Professionals Full time

    Jackson Nurse Professionals is seeking a skilled travel nurse RN for a home health assignment in Indianapolis, Indiana. **Job Details:** * Shift: Travel * Filling critical needs in patient care, Jackson Nurse Professionals delivers cost-effective travel nurse staffing solutions to over 500 hospitals, outpatient clinics, and home health clients...