Clinical Quality RN Senior
4 weeks ago
At UnitedHealth Group, we are committed to helping people live healthier lives and making the health system work better for everyone. We believe that everyone deserves the opportunity to live their healthiest life, regardless of their background or circumstances.
Job Summary:We are seeking a highly skilled and experienced Sr Clinical Quality RN to join our team. The successful candidate will be responsible for driving consistency, efficient processes, and sharing best practices in a collaborative effort with providers and large or complex groups. The Sr Clinical Quality RN 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
- 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
We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced Sr Clinical Quality RN looking for a new challenge, we encourage you to apply.
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