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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Registered Nurse HEDIS/STARS Consultant
Location
United States
Posted
15 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
The Clinical Quality Consultant will drive consistency, efficient processes and share best practices - in a collaborative effort with the Quality Improvement team and leadership - designed to facilitate a minimum 4 STAR rating. This position will work collaboratively with other staff members, leadership and the market in a matrix relationship.
- Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
- Outreach to members to provide patient education & assessments, medication reconciliation post discharge, comprehensive diabetes care, and other quality campaign initiatives
- 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 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
Qualifications
- Registered Nurse with an undergraduate degree or equivalent experience
- Professional experience persuading changes in behavior
- Knowledge base of clinical standards of care, preventative health, and STAR measures
- Microsoft Office specialist with exceptional attention to detail
Requirements
- 3+ years of associated business experience with health care industry
- 1+ years of HEDIS/Stars experience
- Experience in managed care working with network and provider relations
- Proven knowledge of the Medicare market, products and competitors
- Proven relationship building skills with clinical and non-clinical personnel
- Proven financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
- Demonstrated ability to interact with medical staff
- Demonstrated ability to solve process problems crossing multiple functional areas and business units
- Proven problem-solving skills; the ability to analyze problems
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
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.
Job Requirements
- Registered Nurse with an undergraduate degree or equivalent experience
- Professional experience persuading changes in behavior
- Knowledge base of clinical standards of care, preventative health, and STAR measures
- Microsoft Office specialist with exceptional attention to detail
- 3+ years of associated business experience with health care industry
- 1+ years of HEDIS/Stars experience
- Experience in managed care working with network and provider relations
- Proven knowledge of the Medicare market, products and competitors
- Proven relationship building skills with clinical and non-clinical personnel
- Proven financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
- Demonstrated ability to interact with medical staff
- Demonstrated ability to solve process problems crossing multiple functional areas and business units
- Proven problem-solving skills; the ability to analyze problems
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
- 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.
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