Job Details

RN-HEDIS-Clinical-Quality-Consultant--Dallas-TX-3k-Sign-on-Bonus-For-External-Candidates

Company name
UnitedHealth Group

Location
Dallas, TX

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$3,000 Sign-on bonus!

This position requires you to be in the field traveling in the Central Dallas, Irving and Richardson Market on a daily basis to different provider offices.

This position has a potential to work from home once training / orientation is completed and strong performance is maintained.

The Clinical Quality Consultant will drive consistency, efficient processes and share best practices – in a collaborative effort with the providers – designed to facilitate a minimum 4 STAR rating.  The CQC will participate in quality improvement initiatives, 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.  

Primary Responsibilities:

Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher

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

Required Qualifications: 

Registered Nurse with Undergraduate degree or equivalent experience

1 years of HEDIS / Stars experience

3 years associated business experience with health care industry

Professional experience persuading changes in behavior

Strong 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

Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)

Microsoft Office specialist with exceptional attention to detail

Preferred Qualifications: 

Strong communication and presentation skills

Strong 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

Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

Good business acumen, especially as it relates to Medicare

Medical / clinical background highly desirable

Undergraduate degree preferred, post graduate degree 

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 90,000 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)

**PLEASE NOTE** The sign on bonus is only available to external candidates.  Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.

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.

Job Keywords: HEDIS, RN, registered nurse, chart review, quality, Dallas, TX, Texas, quality consultant, STARS, HOS, CAHPS, CORE

Company info

UnitedHealth Group
Website : http://www.unitedhealthgroup.com/

Company Profile
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term

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