Senior Clinical Quality RN - Office-Based

UnitedHealth Group•Las Vegas, NV

18d•$72,800 - $130,000•Hybrid

About The Position

The Senior Clinical Quality RN (Senior Clinical Quality Consultant RN) drives consistency, efficient processes, and the sharing of best practices with providers and large or complex groups to support quality performance of at least 4 Stars. The role participates in quality improvement initiatives, attends monthly or joint operating committee meetings, develops recommendations for quality remediation plans, and creates tools and databases to capture relevant regional data. It works collaboratively with regional and market teams and their leadership in a matrix relationship, and may serve as team lead for clinical quality consultants in the assigned market, with responsibility for network quality performance. The role develops market business plans and provides analytical interpretation of Stars and HEDIS reporting, including executive summaries for plan and provider groups. It serves as the subject matter expert for Stars-related activity in assigned markets and leads or participates in business review meetings about provider, large-group, and market performance. It also evaluates provider and group operations to identify effective approaches and helps develop Stars and HEDIS training and analytical materials. This is an office-based position with three days per week in the office or field and two days remote or at home, subject to business needs. The position requires local field travel, including rural and outlying areas, for approximately 35% of the time, with occasional overnight travel.

Requirements

Current unrestricted Registered Nurse license in Nevada.
BLS certification.
At least 4 years of healthcare experience, including experience in a managed care setting.
At least 2 years of experience in provider-facing interactions, including provider education.
At least 2 years of experience with data analysis and/or quality chart reviews, with the ability to review data and provide recommendations for improvement.
Ability to travel locally approximately 35%, with occasional overnight travel.
Driver’s license and access to reliable transportation.

Nice To Haves

Undergraduate or postgraduate degree.
At least 2 years of experience in HEDIS/Stars programs, preferably in a clinical quality consultant role.
Billing and CPT coding experience.
Clinical data abstraction experience.
Experience using Microsoft Office applications, including databases, word-processing applications, and Excel spreadsheets; proficiency in Excel.
Medicare experience.

Responsibilities

Develop market business plans that motivate providers and large or complex group leadership to improve Stars measures to 4 Stars or higher.
Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries for plan and provider groups.
Serve as the primary subject matter expert for Stars-related activities in assigned markets, working across Quality corporate and Regional/Market operations in a matrix relationship.
Lead or participate in weekly, monthly, bi-monthly, quarterly, and/or annual business review meetings related to Stars activities, summarizing provider, large-group, and market performance as requested or required by Quality or Regional leadership.
Analyze and evaluate provider and large-group structure and characteristics, as well as provider group and office operations and personnel, to identify effective approaches and strategies.
Assist in developing Stars and HEDIS training and analytical materials.
Participate in quality improvement initiatives and attend monthly or joint operating committee meetings.
Develop recommendations for quality remediation plans and create tools and databases to capture relevant regional data.
Collaborate with regional and market teams and their leadership; may serve as team lead for clinical quality consultants in the assigned market.