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Registered Nurse RN HEDIS/STARS Consultant Houston TX

Company: UnitedHealth Group
Location: Sugar Land
Posted on: January 15, 2020

Job Description:

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 380,000+ 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) 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) WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella. 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. The CQC will participate in quality improvement initiatives, such as Medication Reconciliation Post Discharge (MRP), and Comprehensive Diabetes Care (CDC) and develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with other staff member, leadership and the market 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 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 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 is an office-based position near W Loop South, Houston, TX 77027 This position has occasional local and non-local travel required as determined by the business supporting clinics’ and doctors’ offices throughout Houston Texas area 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 with Undergraduate degree or equivalent experience 1 year of HEDIS/Stars experience 3+ years associated business experience with health care industry Professional experience persuading changes in behavior Strong knowledge of the Medicare market, products and competitors Knowledge base of clinical standards of care, preventative health, and Star measures Experience in managed care working with network and provider relations Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models) Microsoft Office specialist with exceptional attention to detail Preferred Qualifications: Call Center Experience 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 Medical/clinical background highly desirable Undergraduate degree preferred, post graduate degree highly 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 receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving We’re on a mission to change the face of health care. And at Optum Health, the largest health and wellness business in the U.S., we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, as a thriving part of the UnitedHealth Group family of companies, we have a team of the best and brightest minds on the planet to make it happen. Together we’re creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life’s best work. 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 380,000+ 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) 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 Job keywords:  WellMed, Healthcare, Bilingual, Registered Nurse, RN, Clinical Educator, Quality Training Lead, HEDIS/STAR, Consultant, Chart Review, Houston, Galveston, Harris, Fort Sam, Beaumont Texas, TX

Keywords: UnitedHealth Group, Sugar Land , Registered Nurse RN HEDIS/STARS Consultant Houston TX, Other , Sugar Land, Texas

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