Senior Quality Nurse

2 weeks ago


Albuquerque, New Mexico, United States Optum Full time

Transforming Healthcare through Quality Excellence

The Sr. Clinical Quality Consultant (CQC) RN at Optum will drive consistency, efficient processes, and share best practices in a collaborative effort with providers and large or complex groups, designed to facilitate a minimum 4 STAR quality performance.

Key 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

Requirements:

  • 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 Driver's 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 Optum, 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.

Diversity creates a healthier atmosphere: Optum 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.

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


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