RN Senior Clinical Quality Consultant Compact Lics Telecommute - Quality Assurance
Company: UnitedHealth Group Inc
Location: San Antonio
Posted on: April 17, 2024
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Job Description:
RN Senior Clinical Quality Consultant Compact Lics
Telecommute
Opportunities at WellMed, part of the Optum family of businesses.
We believe all patients are entitled to the highest level of
medical care. Here, you will join a team who shares your passion
for helping people achieve better health. With opportunities for
physicians, clinical staff and non-patient-facing roles, you can
make a difference with us as you discover the meaning behind
Caring. Connecting. Growing together.
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
You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. 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
* Mon-Fri 8am-6pm Central and Required Rotating - Saturdays
8am-5:30pm Central. - Hours of Operations
* 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.
Required Qualifications:
* Active, unrestricted Registered Nurse license in
* 4+ years of RN 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 call center experience
* 2+ years of experience with data analysis and/or quality chart
reviews. Must be able to review paper and electronic medical
records and charts
* Proven solid knowledge of the Medicare HEDIS/Stars measures
* Demonstrated ability to interact with medical staff, peers, and
internal company staff at all levels
* 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
* Experienced using Microsoft office applications, including
databases, word-processing, outlook, and excel spreadsheets. Must
be proficient in Excel
* Proven excellent customer service skills and communication
skills
Preferred Qualifications:
* Undergraduate degree or post graduate degree
* Billing and CPT coding experience
* Clinical data abstraction experience
* Adaptable to change
* Good business acumen, especially as it relates to Medicare
* Bilingual/Vietnamese
* All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New
York, Rhode Island, or Washington Residents Only: The salary range
for California, Colorado, Connecticut, Nevada, New Jersey, New
York, Rhode Island or Washington residents is $70,200 to $137,800
annually. 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.
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 Inc, San Antonio , RN Senior Clinical Quality Consultant Compact Lics Telecommute - Quality Assurance, Healthcare , San Antonio, Texas
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