Senior Quality RN San Antonio TX - Quality Assurance

Company: UnitedHealth Group Inc
Location: San Antonio
Posted on: March 19, 2023

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