RN Clinical Quality Consultant Laredo

Company: Optum
Location: Laredo
Posted on: June 24, 2022

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

The Clinical Quality Consultant will drive consistency, efficient processes and share best practices - in a collaborative effort with the providers - designed to facilitate a minimum 4 STAR rating. The CQC will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship.

Primary Responsibilities:

• 
  
• Develop market business plans to motivate providers 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 go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations.
  
• Assist in developing of training and analytical materials for Stars and HEDIS
  
• Lead Weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership
  
• Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
  
• Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes
  
• Focus communications and efforts accordingly
  
• Develop solution-based, user friendly initiatives to support practice success
  
  
  
  You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
  Required Qualifications:
  
  
  • 
    
  • Registered Nurse with Undergraduate degree or equivalent experience
    
  • 3+ years of associated business experience with health care industry
    
  • 1+ years of HEDIS / Stars experience
    
  • Professional experience persuading changes in behavior
    
  • Experience in managed care working with network and provider relations
    
  • Solid knowledge of the Medicare market, products and competitors
    
  • Knowledge base of clinical standards of care, preventative health, and Star measures
    
  • Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
    
  • Microsoft Office specialist with exceptional attention to detail
    
  • This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
    
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance
    
    
    Preferred Qualifications:
    
    
    • 
      
    • Undergraduate degree preferred, post graduate degree
      
    • Medical / clinical background
      
    • Solid communication and presentation skills
      
    • Solid relationship building skills with clinical and non-clinical personnel
      
    • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
      
    • Ability to solve process problems crossing multiple functional areas and business units
      
    • Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
      
    • Good business acumen, especially as it relates to Medicare
      
      
      
      To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
      
      Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
      
      WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
      
      
      Diversity creates a healthier atmosphere: 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.
      
      OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Laredo , RN Clinical Quality Consultant Laredo, Healthcare , Laredo, Texas