RN Senior Clinical Quality Consultant Houston Texas

WellMed, part of the Optum family of businesses, is seeking a Registered Nurse to join our team in Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

The Sr. Clinical Quality Consultant (CQC) 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.  

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country.

Primary 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 
• 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

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we’re making health care work better for everyone.

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: 

• Registered Nurse (within the states in which service is being delivered) 
• 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
• 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
• Experience in managed care working with network and provider relations
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
• Solid knowledge of the Medicare market, products and competitors
• Proven ability to influence providers to change behavior and drive improvement in quality performance
• Solid communication and presentation skills
• 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
• Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Excellent customer service skills
• Ability to travel 25% local, with occasional overnight travel

  
Preferred Qualifications:    

• Undergraduate degree or post graduate degree
• Billing and CPT coding experience
• Clinical data abstraction experience
• Adaptable to change
• Good business acumen, especially as it relates to Medicare

Physical & Mental Requirements: 

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery 
• Ability to properly drive and operate a vehicle
• Ability to receive and comprehend instructions verbally and/or in writing 
• Ability to use logical reasoning for simple and complex problem solving

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: OptumCare 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment