WellMed, part of the Optum family of businesses, is seeking a Registered Nurse RN Clinical Quality Consultant to join our team in Corpus Christi, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. 

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.

Primary Responsibilities:

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 or participate and present in 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 is an office/field base position

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

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) with undergraduate degree or (4 years equivalent experience above and beyond the required years of experience may be considered in lieu of undergraduate degree)
4+ years of associated business experience within the health care industry including experience with HEDIS/Stars
Experience influencing others resulting in changes in behavior (preferably with providers in various care delivery models)
Experience in managed care working with network and provider relations
Experience in provider-facing HEDIS strategy and education
Experience presenting education of HEDIS/Stars material to providers and provider office staff
Solid knowledge of the Medicare market, products and competitors
Knowledge base of clinical standards of care, preventative health, and Star measures
Proven financial analytical background within Medicare Advantage or government programs (Risk Adjustment/STARS Calculation models)
Microsoft Office specialist with exceptional attention to detail; must be proficient with Excel
50 - 75% local travel required, with occasional overnight travel

Preferred Qualifications:

Undergraduate degree or post graduate degree
Billing and CPT coding experience
Clinical data abstraction experience
Proven solid communication and presentation skills
Proven solid relationship building skills with clinical and non-clinical personnel
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 adaptable to change
Proven excellent customer service skills
Proven good business acumen, especially as it relates to Medicare
Medical/clinical background

Physical & Mental Requirements:

Ability to lift up to 10 pounds
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to properly drive and operate a vehicle
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Registered Nurse RN Clinical Quality Consultant Corpus Christi Texas