$58300 - $114300 Year
Monday to Friday
Day shift
Health insurance
Paid time off
Employee discount
Dental insurance
Vision insurance
401(k)
401(k) matching
Flexible schedule
Parental Leave
Tuition reimbursement
Flexible spending account
Retirement plan
Others
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.
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.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
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
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.
Preferred Qualifications:
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
Ability to solve process problems crossing multiple functional areas and business units
Proven problem-solving skills; the ability to analyze problems
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
New Jersey Residents Only: The salary range for New Jersey residents is $58,300 to $114,300 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.
Communication
Leadership
Teamwork
Interpersonal
Learning/adaptability
Self-management
Organizational
Computer
Problem solving
Open mindedness
Strong work ethic
technology
Others
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
Health care
3
Remote