Clinical Quality Nurse Specialist

4 weeks ago

Wichita Falls, Texas, United States UnitedHealth Group Full time
Job Title: Sr Clinical Quality RN

Job Summary:

We are seeking a highly skilled Sr 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 participate in quality improvement initiatives, attend monthly or joint operating committee meetings, develop recommendations for quality remediation plans, and create tools and databases to capture relevant data for each region.

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
  • 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
  • Medicare experience
  • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
  • Ability to travel locally 25%, with occasional overnight travel

About UnitedHealth Group:

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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. 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.

Equal Employment Opportunity:

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.

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

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