RN Senior Clinical Quality Consultant Compact Lics Telecommute

2 weeks ago

San Antonio, Texas, United States UnitedHealth Group Inc Full time
Senior Clinical Quality Consultant RN Compact Lics Telecommute

At UnitedHealth Group, we believe that everyone deserves access to quality healthcare. As a Senior Clinical Quality Consultant RN, you will play a critical role in helping us achieve this mission. Our team is dedicated to delivering patient-centered, clinically collaborative telephonic outreach to help people live healthier lives.

Key Responsibilities:
  • Perform telephonic, patient-centered clinical consults focused on Care for Older Adults annual pain and functional assessments.
  • Outreach telephonically for Transition of Care following hospital discharge to complete reviews and assist with appointment scheduling.
  • Meet or exceed established productivity and quality metrics while working a flexible schedule to support the hours of operation of the business.
  • Strictly adhere to department's metrics and established advanced protocols and handle incoming contacts, including prescription refill requests, lab results, x-ray results, medical inquiries, patient education, and referral requests.
  • Review patient chart to ensure core measures are being addressed and met per protocol and take appropriate action when they are not.
  • Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments.
  • Educate patients on health conditions and necessity of route screening but assist with appointment scheduling.
  • Communicate with providers and offices to obtain needed evidence of completed lab work, screenings, and care provided.
  • Review available medical records for core measures to submit for closure of HEDIS/STARS measures.
  • Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs.
  • Document thoroughly all calls and actions taken within core systems.
Requirements:
  • Active, unrestricted Registered Nurse license.
  • 4+ years of RN 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 call center experience.
  • 2+ years of experience with data analysis and/or quality chart reviews.
  • Proven solid knowledge of the Medicare HEDIS/Stars measures.
  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels.
  • Ability to manage multiple complex, concurrent projects.
  • Proven excellent written and verbal communication and relationship building skills.
  • Demonstrated solid problem-solving skills.
  • Experienced using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets.
Preferred Qualifications:
  • Undergraduate degree or postgraduate degree.
  • Billing and CPT coding experience.
  • Clinical data abstraction experience.
  • Adaptable to change.
  • Good business acumen, especially as it relates to Medicare.
  • Bilingual/Vietnamese.

UnitedHealth Group 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.

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