Registered Nurse RN HEDIS/STARS Consultant Compact Lics
About The Position
WellMed, part of the Optum family of businesses, is seeking a Registered Nurse RN HEDIS/STARS Consultant Compact Lics to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while 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. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 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.
Requirements
- 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
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Nice To Haves
- 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
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
Benefits
- In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
