Healthcare Quality Improvement Specialist
2 weeks ago
For those who aspire to revolutionize the healthcare landscape, we offer an unparalleled opportunity. UnitedHealth Group is pioneering a new era of comprehensive care, where patient-centered solutions meet cutting-edge innovation.
The Senior Quality Nurse will be instrumental in driving consistency, efficiency, and best practices across the continuum of care. Collaborating with providers and large groups, this role will focus on achieving a minimum 4 STAR quality performance.
This position requires a provider-facing approach, participating in quality improvement initiatives, attending regular committee meetings, and developing recommendations for enhanced quality delivery. The successful candidate will work closely with the market team and leadership in a matrix relationship, ensuring seamless execution of quality objectives.
Key Responsibilities:
- Develop business strategies to motivate providers in improving STARS measure performance
- Provide data-driven insights and summaries on STARS/HEDIS performance to provider groups
- Serve as the subject matter expert for all STARS-related activities within their assigned territory, working within a matrix relationship
- Present at regular business review meetings related to STAR activities, summarizing provider performance
- Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel, to identify effective approaches for improving STARS measure performance
- Assist in creating STARS/HEDIS presentation materials for provider performance meetings
In this dynamic environment, you'll be rewarded and recognized for your performance while having clear direction on what it takes to succeed in your role and opportunities for development in other areas.
**Requirements:**
- Registered Nurse (RN) licensure in New Mexico or a compact state; alternatively, 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
- Proficiency in Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
- Ability to review clinical data and provide recommendations for improvement
- Valid New Mexico Driver's license and ability to travel locally (75%) for meetings and site visits
**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
Estimated Salary: $80,000 - $120,000 per year, depending on location and experience.
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