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Licensed Vocational Nurse for Quality Assurance

2 months ago

Ingleside, Texas, United States UnitedHealth Group Full time

Opportunities at UnitedHealth Group, a member of the Optum family of businesses. We are dedicated to ensuring that all patients receive the highest standard of medical care. Here, you will collaborate with a team that shares your commitment to enhancing health outcomes. With roles available for healthcare professionals and administrative staff, you can contribute to our mission as you explore the essence of **Caring. Connecting. Growing together.**

This role is focused on overseeing the HEDIS and STARs data collection processes within a clinical environment. The position entails educating the clinic staff on quality metrics and devising strategies to address gaps in care. Responsibilities include assessing the quality and thoroughness of clinical documentation through systematic reviews, facilitating enhancements in documentation practices, maintaining precise records of review activities, developing formal training and improvement initiatives, and staying informed about regulatory standards and guidelines related to HEDIS/STARs.

Key Responsibilities:

  • Conduct data analysis, assess for potential data integrity issues, and document findings
  • Evaluate and trend HEDIS/STAR rates, identify obstacles to rate improvement, and create interpretive reports
  • Retrieve quality detail reports and flag patient records for missing measures
  • Collaborate closely with local leadership to implement quality improvement strategies
  • Assist primary care providers and clinics with quality data collection efforts
  • Generate reports and monitor performance metrics at the local level
  • Engage with primary care providers and clinic personnel to develop strategies for closing quality gaps
  • Enhance communication between market and corporate departments
  • Maintain a comprehensive understanding of HEDIS/STARs standards and guidelines
  • Perform additional related duties as assigned

You will be acknowledged and rewarded for your contributions in an environment that challenges you and provides clear guidance on achieving success in your role, as well as opportunities for professional development in other areas of interest.

Required Qualifications:

  • Licensed Vocational/Professional Nurse
  • 3+ years of experience in healthcare, including experience in a managed care setting
  • 3+ years of experience in data analysis and quality chart reviews, with the ability to assess data and provide improvement recommendations
  • Experience with HEDIS/STAR reporting or similar regulatory frameworks
  • Proficient in Microsoft Office applications, including databases, word processing, and spreadsheets
  • Willingness to travel locally up to 50-75%
  • This position requires Tuberculosis screening and proof of immunity to certain diseases through lab confirmation, vaccination documentation, or a physician's diagnosis

Preferred Qualifications:

  • 2+ years of college education towards a Bachelor's or Associate's degree
  • 2+ years of experience working with HEDIS/STAR measures

Physical & Mental Requirements:

  • Ability to push or pull heavy objects using significant force
  • Capability to drive and operate a company vehicle safely

At UnitedHealth Group, our mission is to empower individuals to lead healthier lives and enhance the effectiveness of the health system for everyone. We believe that every individual, regardless of race, gender, sexuality, age, location, or income, deserves the opportunity to achieve their healthiest life. However, numerous barriers to good health persist, disproportionately affecting people of color, historically marginalized groups, and those with lower incomes. We are committed to reducing our environmental impact and delivering equitable care that addresses health disparities and improves health outcomes, which is a priority reflected in our mission.

Diversity fosters a healthier environment: 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.

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