Lead Quality Assurance Nurse

2 months ago

Albuquerque, New Mexico, United States UnitedHealth Group Full time

For those aspiring to shape the future of healthcare, this is your chance. We are advancing beyond conventional care to health initiatives that are integrated throughout the entire spectrum of care. Join us to begin Caring. Connecting. Growing together.

The Senior Clinical Quality Consultant (CQC) RN will promote uniformity, streamline processes, and disseminate best practices in a collaborative effort with healthcare providers and large or intricate groups, aimed at achieving a minimum 4 STAR quality performance.

The Senior CQC will engage directly with providers and take part in quality enhancement initiatives, attend regular operational committee meetings, and formulate recommendations for quality advancement. This role is accountable for quality performance within their designated region and will collaborate closely with the market team and their leadership in a matrix structure.

Key Responsibilities:

  • Create strategic plans to encourage providers to enhance STARS measure performance.
  • Deliver analytical insights and STARS/HEDIS performance summaries to provider groups.
  • Serve as the subject matter expert for all STARS-related activities within their designated territory, working within a matrix structure.
  • Participate and present in weekly, monthly, bi-monthly, quarterly, and/or annual business review meetings related to STAR activities that summarize provider performance.
  • Assess and evaluate provider structures and characteristics, including EMR utilization, office operations, and personnel to identify the most effective strategies to enhance STARS measure performance.
  • Assist in the development of STARS/HEDIS presentation materials for provider performance meetings.

You will be acknowledged and rewarded for your contributions in an environment that will challenge you and provide clear guidance on what it takes to excel in your role, as well as offer development opportunities for other positions you may be interested in.

Required Qualifications:

  • Registered Nurse in NM and/or a compact state. Alternatively, a Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs is acceptable.
  • 4+ years of experience in the healthcare sector.
  • 2+ years of experience in provider-facing roles.
  • Proficiency in Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets.
  • Capability to review clinical data and provide actionable recommendations for improvement.
  • Valid NM Driver's license and willingness to travel locally up to 75% of the time.

Preferred Qualifications:

  • 2+ years of experience in HEDIS/STARS, ideally in a clinical quality consultant capacity.
  • 2+ years of experience in data analysis and/or quality chart review and abstraction.
  • Familiarity with billing and CPT coding.
  • Experience in Medicare and/or Managed Care.

Physical & Mental Requirements:

  • Ability to lift up to 10 pounds.
  • Ability to push or pull heavy objects.
  • Ability to sit for extended periods.
  • Ability to stand for extended periods.
  • Ability to use fine motor skills to operate office equipment and/or machinery.
  • Ability to properly drive and operate a vehicle.
  • Ability to comprehend instructions both verbally and in writing.
  • Ability to apply logical reasoning for simple and complex problem-solving.

At UnitedHealth Group, our mission is to assist individuals in leading healthier lives and to enhance the health system for everyone. We believe that everyone—regardless of race, gender, sexuality, age, location, or income—deserves the opportunity to live their healthiest life. However, there are still significant barriers to good health that disproportionately affect people of color, historically marginalized groups, and those with lower incomes. We are dedicated to reducing our environmental impact and delivering equitable care that addresses health disparities and improves health outcomes—an enterprise priority reflected in our mission.

Diversity fosters a healthier environment: OptumCare 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.

OptumCare maintains a drug-free workplace. Candidates are required to pass a drug test prior to commencing employment.

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