Quality Improvement Licensed Vocational Nurse

3 days ago

San Antonio, Texas, United States UnitedHealth Group Full time

Join WellMed, a proud member of the Optum family, where we prioritize delivering exceptional medical care to all patients. As part of our dedicated team, you will contribute to enhancing health outcomes and experience the essence of **Caring. Connecting. Growing together.**

This role focuses on overseeing the HEDIS and STARs data collection processes within a clinical environment. You will be responsible for educating clinic staff on quality metrics and implementing strategies to address identified gaps. This position involves evaluating the quality and thoroughness of clinical documentation through comprehensive medical record assessments, aiding in the enhancement of documentation practices, keeping precise records of review activities, developing structured training and improvement initiatives, and staying informed about regulatory standards and guidelines related to HEDIS/STARs.

Key Responsibilities:

  • Conduct data analysis to assess integrity and identify deficiencies, documenting all findings.
  • Analyze and track HEDIS/STAR performance metrics, pinpointing barriers to improvement and creating interpretive reports.
  • Retrieve quality detail reports and highlight patient charts with missing measures.
  • Collaborate closely with local leadership to implement quality improvement strategies.
  • Assist primary care providers and clinics in the collection of quality data.
  • Generate reports and monitor performance metrics at the local level.
  • Engage with primary care providers and clinic personnel to develop strategies for closing quality gaps.
  • Foster improved communication between market and corporate departments.
  • Maintain a comprehensive understanding of HEDIS/STARs standards and guidelines.
  • Perform additional related duties as assigned.

Required Qualifications:

  • Licensed Vocational/Professional Nurse.
  • Previous experience with HEDIS/STAR or similar regulatory reporting.
  • Minimum of 3 years in healthcare, including experience in a managed care setting.
  • At least 3 years of experience in data analysis and quality chart reviews, with the ability to assess data and provide actionable recommendations.
  • Proficient in Microsoft Office applications, including databases, word processing, and spreadsheets.
  • This position requires both office and fieldwork.

Preferred Qualifications:

  • At least 2 years of college education towards a Bachelor's or Associate's degree.
  • A minimum of 2 years of experience working with HEDIS/STAR measures.

Physical & Mental Requirements:

  • Ability to lift up to 25 pounds.
  • Capacity to sit for extended periods.
  • Ability to stand for prolonged durations.
  • Proficient use of fine motor skills for operating office equipment.
  • Ability to comprehend and follow verbal and written instructions.
  • Capability to apply logical reasoning for problem-solving, both simple and complex.

At UnitedHealth Group, our mission is to empower individuals to lead healthier lives and enhance the efficiency of the health system for everyone. We are committed to ensuring equitable care that addresses health disparities and improves health outcomes.

Diversity fosters a healthier environment: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. 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.

UnitedHealth Group maintains a drug-free workplace. Candidates are required to pass a drug test prior to employment.

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