RN Clinical Quality/Primary Source Verification Compact Lics

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 RN will drive consistency, efficient processes and share best practices in a collaborative effort with the Quality team and leadership in order to facilitate a minimum 4 STAR rating. The Clinical Quality RN will participate in quality improvement initiatives including Chart Chase and Supplemental Data Source (SDS) and Primary Source Verification (PSV) as well as Quality Assurance and Overreading work. This position will work collaboratively with other staff members, managers and leadership and the market in a matrix relationship.

If you have a Compact Lics, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Complete SDS, PSV, Over-read throughout the year achieving and maintaining high productivity goals in order to improve Stars measures to be 4 STARS or higher
• Achieve and maintain a high level of accuracy rates of 98% or above
• Serve as a Subject matter expert on HEDIS Measures, DataRAP and Chart Chase Tool (CCT)
• 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
• Assist in developing of training and materials to help team achieve best practices in Stars and HEDIS
• Performance as requested by or required by Quality
• 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
  

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:

• Bachelor of Science in Nursing, Healthcare Administration or a related field required. (Eight additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
• Registered Nurse with current license in Texas, or other participating States
• 5+ years of progressively responsible healthcare experience to include experience in a managed care setting, and/or hospital settings, and/or physician practice setting
• 3+ years of experience in managed care with at least two years of Utilization Management experience
• Knowledge and experience with CMS, and/or NCQA
• Proficiency with Microsoft Office applications
• Willing to occasionally travel in and/or out-of-town
  

Preferred Qualifications:

• Health Plan or MSO quality, audit or compliance experience
• Solid Knowledge of Medicare and HEDIS standards
• Auditing, training or leadership experience 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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