Senior Quality RN San Antonio TX - Quality Assurance
Company: UnitedHealth Group Inc
Location: San Antonio
Posted on: March 19, 2023
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Job Description:
Senior Quality RN 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 WellMed Quality Clinical Programs team supports WellMed Medical
Management by delivering patient-centered, clinically collaborative
telephonic outreach to help people live healthier lives. Our team
focuses on the design, execution, and delivery of telephonic and
digital engagement strategies designed to close STARs measure gaps
in care, e.g. medication adherence, care for older adults,
medication reconciliation post discharge, A1c, etc. Our
interdisciplinary service delivery team is comprised of Registered
Nurses, Licensed Vocational Nurses, and Social Workers.
The Registered Nurse will report into the Manager of Clinical
Programs. The Registered Nurse will perform telephonic,
patient-centered clinical consults focused on Care for Older Adults
annual pain and functional assessments. In addition, the RN will
outreach telephonically for Transition of Care following hospital
discharge to complete reviews as well as assist with appointment
scheduling. The RN will be required to meet or exceed established
productivity and quality metrics and work a flexible schedule to
support the hours of operation of the business (Mon-Fri 8am-6pm
Central and Saturday 8am-5:30pm Central).
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:
* Strictly adheres to department's metrics and established advanced
protocols and to handle incoming contacts including, but not
limited to, prescription refill requests, lab results, x-ray
results, medical inquiries, patient education and referral
requests
* Primarily to make outbound calls but occasionally help manage the
inbound call queue from patients, patient representatives,
providers and other medical staff, while strictly adhering to
established protocols and scripting
* Review patient chart (in EMR) to ensure core measures are being
addressed and met per protocol and takes appropriate action when
they are not, i.e., schedule services
* Complete patient assessments for Transition of Care Medication
Reconciliation Post Discharge, Care for Older Adults Pain and
Function Assessments
* Educate patients on health conditions and necessity of route
screening but assisting with appointment scheduling (A1c, Breast
Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam,
etc.)
* Communicate with providers and offices to obtain needed evidence
of completed lab work, screenings and care provided
* Review available medical records for core measures to submit for
closure of HEDIS/STARS measures
* Assist patients with identification of and connectivity to
community and program resources to assist with non-medical needs,
(Pharmacy assistance programs, meals on wheels, LIS)
* Document thoroughly all calls and actions taken within core
systems
* 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:
* Associates Degree in Nursing
* Hold active, unrestricted Registered Nurse license in the state
of Texas
* 4+ years of RN experience, including experience in a managed care
setting
* Experienced using Microsoft office applications, including
databases, word-processing, outlook, and excel spreadsheets.
Proficient in Excel
* Solid knowledge of the Medicare HEDIS/Stars measures
* Demonstrated ability to review paper and electronic medical
records and charts
* Demonstrated ability to interact with medical staff, peers, and
internal company staff at all levels
* Demonstrated ability to manage multiple complex, concurrent
projects
* Proven excellent written and verbal communication and
relationship building skills
* Demonstrated solid problem-solving skills; the ability to analyze
problems, draw relevant conclusions and devise and implement an
appropriate plan of action
* Proven excellent customer service skills and communication
skills
Preferred Qualifications:
* Undergraduate degree, post graduate degree highly preferred
* 2+ years of experience in HEDIS/Star programs, preferably in a
clinical quality consultant role
* 2+ years of Call Center Experience
* 2+ years of experience with data analysis and/or quality chart
reviews
* Billing and CPT coding experience
* Clinical data abstraction experience
* Bilingual with preference given to Spanish and Vietnamese
* Good business acumen, especially as it relates to Medicare
* Proven adaptable to change
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: 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.
Keywords: UnitedHealth Group Inc, San Antonio , Senior Quality RN San Antonio TX - Quality Assurance, Healthcare , San Antonio, Texas
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