Registered Nurse RN HEDIS/STARS Consultant – Telecommute

UnitedHealth Group
Published
January 1, 2022
Location
San Antonio, TX
Category
Job Type

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) 

WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

The Clinical Quality Consultant will drive consistency, efficient processes and share best practices - in a collaborative effort with the Quality Improvement team and leadership - designed to facilitate a minimum 4 STAR rating. The CQC will participate in quality improvement initiatives, such as Medication Reconciliation Post Discharge (MRP), and Comprehensive Diabetes Care (CDC) and develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with other staff member, leadership and the market in a matrix relationship.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:

  • Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
  • Outreach to members to provide patient education & assessments, medication reconciliation post discharge, comprehensive diabetes care, and other quality campaign initiatives
  • 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 an 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
  • Proven knowledge of the Medicare market, products and competitors
  • Knowledge base of clinical standards of care, preventative health, and Star measures
  • Experience in managed care working with network and provider relations
  • Proven financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
  • Microsoft Office specialist with exceptional attention to detail

Preferred Qualifications:

  • Post graduate degree 
  • Call Center Experience
  • Medical/clinical background 
  • Bilingual in English/Spanish
  • Proven communication and presentation skills
  • Good business acumen, especially as it relates to Medicare
  • Proven 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
  • Proven problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Physical & Mental Requirements: 

  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 to $95,100. The salary range for Connecticut / Nevada residents is $58,800 to $104,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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

Job Keywords: Registered Nurse RN HEDIS/STARS Consultant WellMed, Healthcare, Bilingual, Registered Nurse, RN, Clinical Educator, Quality Training Lead, HEDIS/STAR, Consultant, Chart Review, San Antonio, Dallas, Houston, Miami, Orlando, Jacksonville, Texas, TX, Florida, FL, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

Apply
Drop files here browse files ...

Related Jobs

Relief Cook   San Antonio, TX new
January 22, 2022
January 22, 2022
Retail Sales Associate   Selma, TX new
January 22, 2022
Baker - Work When You Want   Balcones Heights, TX new
January 22, 2022
Regional HR Manager (CA)   Atlanta, GA new
January 22, 2022

Author: