Clinical Quality Consultant II

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 Clinical Quality Consultant II (CQC) will drive consistency, efficient processes and share best practices, in a collaborative effort with the providers, designed to facilitate a minimum 4 STAR performance.  The 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.

 

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.
• Lead or participate and present 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.
• 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
• Performs all other related duties as assigned

 

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: 

• 2+ years Healthcare/Health Plan experience 
• 2+ years HEDIS experience and/or knowledge   
• Solid knowledge of managed care requirements related to clinical quality 
• Solid proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint
• Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets 
• Proven solid data management and/or project management skills 
• Proven excellent team development skills 
• Proven solid interpersonal skills 
• Proven excellent time management and prioritization skills 
• Proven excellent written and verbal communications skills 

 

Preferred Qualifications:

• Significant Clinical and/or Health Education experience 
• Experience working with HEDIS software vendors (management, building relationships, issue resolution etc.) 
• Experienced in medical record review 
• Proficiency with Microsoft Windows Suite (PPT, Excel, Word, Visio) 
• Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma, Lean, and/or PDSA

 

Physical & Mental Requirement:

• Ability to push or pull heavy objects using pounds of force 

 

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.