About the position
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 Clinical Program Consultant, provides an education and training program for a team of staff that supports care delivery organizations within OptumCare. This role is responsible for creation of quality education materials, inclusive of performance measures within NCQA HEDIS and CMS Medicare Stars; best practice documents that support quality improvement strategies for these measures; and training materials that support quality processes and systems integral to quality functions such as provider point of care quality tools and supplemental data management systems. The ideal candidate has strong expertise in quality measures, quality rating systems and the ability to interpret HEDIS and CMS Stars specifications and regulations to create educational and training material for internal and external customers. The candidate needs to be detailed oriented and able to take complex information and translate it into simpler context for educating others. This position will require experience in creating provider and member facing materials and experience in working in cross-functional teams and presenting to different types of audiences.
Responsibilities
- Responsible for development of quality education content for internal staff, providers and members and ensuring quality education materials are up-to-date, professionally created, and optimize learning for markets and CP Quality organization
- Responsible for researching and development of best practice documents that support quality improvement strategies for provider and member initiatives to improve metrics
- Responsible for document repository management, intake of requests, and cloud-based sites
- Responsible for evaluating, development and updating SOPs, workflows, and job aids
- Responsible for management of NCQA PCS Q&A and ad-hoc trainings for annual and interim changes to CMS Stars and NCQA HEDIS quality measures
- Support and back-up for quality training and onboarding including quality systems such as supplemental data and primary source verification systems for CP Quality teams providing central services to our markets, and development and updating training materials
- Responsible for supporting director for HEDIS and Stars training
- Support director as a subject matter expert not only through development of quality materials but also as a consultant within the CP Quality organization and to our markets
- Participates in various cross-functional teams, committees and meetings at any level required to meet key business goals
Requirements
- 5+ years of experience working with quality performance measures, quality rating systems, and quality improvement programs
- 2+ years of experience working with CMS Medicare Stars quality programs, inclusive of CAHPS, HOS, and NCQA HEDIS measures
- 2+ years of experience with quality improvement efforts focused on provider and member strategies, and data and analytic strategies
- 2+ years of experience with learner-centric approach to promote engagement and active participation by all learners (e.g., technology usage, questioning techniques, story generation)
- 2+ years of expertise in NCQA HEDIS measures, including understanding of technical specifications for at least a subset of measures, and experience participating in annual review of changes
- 1+ years of experience presenting to executive teams and other layers of leadership within an organization
- Active and unrestricted Registered Nurse license in any US state
- Experience with technology to develop educational materials, workflows and deliver presentations (e.g. Microsoft office Word, PowerPoint, Visio, and Teams)
- Ability and willingness to travel both locally and non-locally up to 25%
Nice-to-haves
- Bachelor's Degree
- 2+ years of experience working in a quality department in a managed care organization, or in the quality department of a care delivery organization
- HEDIS chart abstraction experience
- Experience in provider facing role
- Experience establishing and maintaining effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
- Experience and knowledge of at least one other managed care population such as Medicaid or Commercial in addition to Medicare
- Detailed oriented and excellent organizational skills
- Excellent verbal, written communication, presentation, and facilitation skills
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
