Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
The 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 CQC 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 each regional/market team and their leadership in a matrix relationship.
If you are located in McAllen, TX, you will have the flexibility to telecommute* as you take on some tough challenges.
$1,500 Sign-On Bonus for External Candidates!
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.
Assist in developing of training and analytical materials for Stars and HEDIS
Lead 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
This position will be office based in McAllen, TX when not traveling in the field 75% of the time. Field work at provider offices in the McAllen and surrounding areas.
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.
Registered Nurse with Undergraduate degree or equivalent experience
3+ years of associated business experience with health care industry
1+ years of HEDIS / Stars experience
Professional experience persuading changes in behavior
Experience in managed care working with network and provider relations
Strong knowledge of the Medicare market, products and competitors
Knowledge base of clinical standards of care, preventative health, and Star measures
Microsoft Office specialist with exceptional attention to detail
Undergraduate degree preferred, post graduate degree
Medical / clinical background
Strong communication and presentation skills
Strong relationship building skills with clinical and non-clinical personnel
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
Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
Good business acumen, especially as it relates to Medicare
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.