HEDIS Clinical Quality Consultant

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.  

The HEDIS Clinical Quality Consultant will drive consistency, efficient processes and share best practices – in a collaborative effort with the providers – designed to facilitate a minimum 4 STAR rating. The HEDIS Clinical Quality Consultant will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with the Senior Quality Consultants for each regional/market. This role will also work collaboratively with the Corporate Quality team on enterprise initiatives and activities in a matrix relationship.

Primary Responsibilities:

• Develop market business plans to motivate providers 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 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
• Participate in 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
• Review provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
• Focus communications and efforts accordingly 
• Develop solution-based, user-friendly initiatives to support practice success

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.

Required Qualifications:

• 1+ years of experience in Healthcare/Health Plan
• 1+ years HEDIS experience and/or knowledge 
• Experience in managed care working with network and provider relations
• Proven solid knowledge of managed care requirements related to clinical quality 
• Proven solid knowledge of the Medicare market, products and competitors
• Microsoft Office specialist with exceptional attention to detail
• Ability to travel 50% of the time within the local market
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease

Preferred Qualifications:

• Clinical and/or health education experience 
• Registered or Certified Medical Assistant
• Proven knowledge base of clinical standards of care, preventative health, and Star measures
• Proven good business acumen, especially as it relates to Medicare
• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
• Ability to solve process problems crossing multiple functional areas and business units
• Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven solid communication and presentation skills
• Proven solid relationship building skills with clinical and non-clinical personnel

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.   

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.