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Senior Clinical Quality RN - Office-Based

OptumSpring Valley, NV🇺🇸United States

Quick overview

Salary$72.8k - $130k/yr
SeniorityMid Senior
Work modeOn Site
LocationSpring Valley, NV, United States
Microsoft ExcelMicrosoft OfficeBLSCPT CodingData Analysis

Job description

Office-based role working in the office/field 3 days a week and remote/home 2 days a week and which is contingent upon the business needs. This does require travel in the field to provide offices approximately 35% of time in rural & outlier areas.

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Sr. Clinical Quality Consultant RN 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.

This position follows an office-based schedule with three in-office days per week.

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 training and analytical materials for Stars and HEDIS

    • 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:

  • Current unrestricted Registered Nurse Nevada license
  • BLS
  • 4+ years of healthcare experience, including experience in a managed care setting
  • 2+ years of experience in provider facing interactions, including provider education
  • 2+ years of experience with data analysis and/or quality chart reviews. Ability to review data and provide recommendations for improvement
  • Ability to travel 35% locally with occasional overnight travel
  • Driver's License and access to reliable transportation

    • Preferred Qualifications:

  • Undergraduate degree, postgraduate degree
  • 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
  • Billing and CPT coding experience
  • Clinical data abstraction experience
  • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Proficient in Excel
  • Medicare experience

    • 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 hourly pay for this role will range from $72,800 - $130,000 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

    At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

    UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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