Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.This is a Hybrid remote position. You will work up to 3 days in the office and the remaining from home (therefore you can be remote while living in the Las Vegas area only).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.If you are located in Las Vegas, NV area, you will have the flexibility to work remotely , as well as work in the office as you take on some tough challenges. It is a hybrid position (3 days in office & 2 days remote) Can only be remote within the Las Vegas, NV area.Primary Responsibilities:
Develops market business plans to motivate providers and large or complex group leadership to engage in improving Stars measures to be 4 STARS or higher
Provides analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
Is 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
Leads or participates and presents 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
Analyzes and evaluates provider and large group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
Assists in developing of training and analytical materials for Stars and HEDIS
Identifies and assesses decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes, focus communications and efforts accordingly
Develops 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:
Registered Nurse (within the states in which service is being delivered). In lieu of RN, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
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
Proven solid communication and presentation skills
Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
Proven ability to solve process problems crossing multiple functional areas and business units
Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
Proven excellent customer service skills
Ability to travel locally up to 25% with occasional overnight travel
Preferred Qualifications:
Undergraduate degree preferred, postgraduate degree highly preferred
Billing and CPT coding experience
Clinical data abstraction experience
Proven adaptable to change
Demonstrated good business acumen, especially as it relates to Medicare
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Nevada Residents Only: The salary range for Nevada residents is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.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.