Remote Registered Nurse RN HEDIS/STARS Consultant Compact Lics

Optum

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Requisition Number: 2232120
Job Category: Nursing
Primary Location: Atlanta, GA
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

 

The Clinical Quality Consultant will drive consistency, efficient processes and share best practices – in a collaborative effort with the Quality Improvement team and leadership – designed to facilitate a minimum 4 STAR rating. The CQC will participate in quality improvement initiatives, such as Medication Reconciliation Post Discharge (MRP), and Comprehensive Diabetes Care (CDC) and develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with other staff member, leadership and the market 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
  • Outreach to members to provide patient education & assessments, medication reconciliation post discharge, comprehensive diabetes care, and other quality campaign initiatives
  • 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

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: 

  • Registered Nurse with an undergraduate degree or equivalent experience
  • Professional experience persuading changes in behavior
  • Knowledge base of clinical standards of care, preventative health, and STAR measures
  • Microsoft Office specialist with exceptional attention to detail

Preferred Qualifications: 

  • 3+ years of associated business experience with health care industry
  • 1+ years of HEDIS/Stars experience
  • Experience in managed care working with network and provider relations
  • Proven knowledge of the Medicare market, products and competitors
  • Proven relationship building skills with clinical and non-clinical personnel
  • Proven financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
  • Demonstrated ability to interact with medical staff
  • Demonstrated ability to solve process problems crossing multiple functional areas and business units
  • Proven problem-solving skills; the ability to analyze problems

*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 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. 

OptumCare is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.