Sr. Clinical Quality RN

UnitedHealth Group • Kansas City, MO

98d • $71,200 - $127,200 • Remote

About The Position

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. The Sr. Clinical Quality RN (Sr. CQRN) 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. CQRN 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 has responsibility for the assigned network's quality performance. If you are located in MO, you will have the flexibility to work remotely* as you take on some tough challenges.

Requirements

• Active, Unrestricted RN License in the state of Missouri
• 4+ years of healthcare experience, including experience in a managed care setting
• 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Proficient in Excel
• Solid understanding of HEDIS measures
• Skilled in identifying and addressing care gaps to improve patient outcomes
• Ability to travel 25% with occasional overnight travel in the MO area
• Driver's license and access to reliable transportation
• Resident of KS or MO

Nice To Haves

• 2+ years of experience in provider facing interactions, including provider education
• 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review data and provide recommendations for improvement
• Billing and CPT coding experience
• Clinical data abstraction experience
• Medicare experience

Responsibilities

• Develop market business plans to motivate providers and large or complex group leadership to engage in improving Stars measures to be 4 STARS or higher
• Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
• Be the primary subject matter expert for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
• Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider and large group performance and market performance as requested by or required by Quality or Regional leadership
• Analyze and evaluate provider and large group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
• Assist in developing of training and analytical materials for Stars and HEDIS

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree