Senior Clinical Quality RN San Antonio TX - San Antonio, TX - Quality Assurance
Company: UnitedHealth Group
Location: San Antonio
Posted on: January 27, 2023
Job Description:
Senior Clinical Quality RN San Antonio TX - San Antonio, TXDo
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 Sr. Clinical Quality RN will drive consistency,
efficient processes and share best practices, in a collaborative
effort with the provider and large or complex groups, designed to
facilitate a minimum 4 STAR quality performance. The Sr CQC 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. This position will work
collaboratively with each regional/market team and their leadership
in a matrix relationship. This position may serve as the team lead
for the clinical quality consultants in the assigned market and has
responsibility for the network's quality performance. -- If you are
located in San Antonio, TX, you will have the flexibility to work
remotely* as you take on some tough challenges.-- -- Primary
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
- Place outbound calls to members to ascertain information from
the patient regarding HEDIS and Quality measures related to their
care as well as obtain member information regarding any possible
gaps in care
- 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 The information listed above is not comprehensive
of all duties/responsibilities performed. This job description is
not an employment agreement or contract. Management has the
exclusive right to alter this job description at any time without
notice
- 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 9.
Develop solution-based, user friendly initiatives to support
practice success 10. Performs all other related duties as assigned
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. -- Monday -
Friday 9am to 6pm-- -- Will rotate a Saturday every couple of
months and when you work a Saturday you have the Monday of that
week off. Required Qualifications:
- Current unrestricted Texas RN License or Compact State
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
- Experience in managed care working with network and provider
relations
- Experienced using Microsoft office applications, including
databases, word-processing, and excel spreadsheets. Must be
proficient in Excel
- Exceptional knowledge of the Medicare market, products and
competitors -- Preferred Qualifications:
- Undergraduate degree, post graduate degree--
- Billing and CPT coding experience
- Call Center Experience
- Clinical data abstraction experience
- Bilingual in Spanish
- Good business acumen, especially as it relates to Medicare
- Adaptable to change--
- Proven ability to influence providers to change behavior and
drive improvement in quality performance
- Solid communication and presentation skills
- 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
- Excellent customer service skills 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. -- *All employees working remotely
will be required to adhere to UnitedHealth Group's Telecommuter
Policy At UnitedHealth Group, our mission is to help people live
healthier lives and make the health system work better for
everyone. We believe everyone-of every race, gender, sexuality,
age, location and income-deserves the opportunity to live their
healthiest life. Today, however, there are still far too many
barriers to good health which are disproportionately experienced by
people of color, historically marginalized groups and those with
lower incomes. We are committed to mitigating our impact on the
environment and enabling and delivering equitable care that
addresses health disparities and improves health outcomes - an
enterprise priority reflected in our mission. -- -- 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. UnitedHealth Group is
a drug-free workplace. Candidates are required to pass a drug test
before beginning employment.
Keywords: UnitedHealth Group, San Antonio , Senior Clinical Quality RN San Antonio TX - San Antonio, TX - Quality Assurance, Healthcare , San Antonio, Texas
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