Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind 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

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 of 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
• Financial analytical background within Medicare Advantage or government programs (Risk Adjustment/STARS Calculation models)
• Solid knowledge of the Medicare market, products and competitors
• Knowledge base of clinical standards of care, preventative health, and Star measures
• Proven Microsoft Office specialist with exceptional attention to detail; must be proficient with Excel
• Willing or ability to up to 50 - 75% local travel, with occasional overnight travel
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease 

Preferred Qualifications: 

• Undergraduate degree, post graduate degree 
• Billing and CPT coding experience
• Clinical data abstraction experience
• Medical/clinical background
• 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
• 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
• Proven solid communication and presentation skills
• Proven solid relationship building skills with clinical and non-clinical personnel

Physical & Mental Requirement:

• Ability to push or pull heavy objects using pounds of force

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.