Requisition Number: 2153318
Job Category: Nursing
Primary Location: Tucson, AZ
***$10,000 Sign On Bonus for External Candidates***
***Position is Hybrid and based in Phoenix or Tucson***
(Time spent in the field, working from home and occasionally in the office for meetings or training)
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Sr. Clinical Quality Consultant 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 Tucson, AZ and surrounding areas, you will have the flexibility to work remotely* as you take on some tough challenges.
- 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
- 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
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.
- Registered Nurse (within the states in which service is being delivered)
- 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
- 25% local travel with occasional overnight travel
- Undergraduate degree, postgraduate degree
- Billing and CPT coding experience
- Clinical data abstraction experience
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
- Medicare experience
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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