Senior Clinical Quality RN - Hybrid East Valley

UnitedHealth Group•Mesa, AZ

4d•$72,800 - $130,000•Hybrid

About The Position

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 the East Valley (Chandler, Mesa, Tempe, Gilbert, Queen Creek) you will have the flexibility to work from home and in the office in this hybrid role as you take on some tough challenges. 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 (within AZ and/or a compact state)
4+ years of healthcare experience
2+ years of experience in provider-facing interactions
Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
Ability to travel locally 50%
Driver’s license and access to reliable transportation

Nice To Haves

2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
2+ years of clinical data abstraction/quality chart review experience
Billing and CPT coding experience
Medicare and/or managed care experience

Responsibilities

Develop business plans to motivate providers to improve STARS measure performance
Provide analytical interpretation and STARS/HEDIS performance summaries to provider groups
Be the subject matter expert for all STARS-related activities within their assigned territory working within a matrix relationship
Participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider performance
Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel to identify the most effective approaches and strategies to improve STARS measure performance
Assist in developing STARS/HEDIS presentation materials for provider performance meetings
Visit patient homes in the East Valley to close gaps in care.