The Clinical Quality Consultant II (CQC) will drive consistency, efficient processes and share best practices, in a collaborative effort with the providers, designed to facilitate a minimum 4 STAR performance. The CQC will participate in quality improvement initiatives, attend monthly or joint operating committee meetings, 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.
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
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
Performs all other related duties as assigned
$3,000 Sign-on bonus for external candidates!
This position has extensive travel in the Dallas Market.
Undergraduate degree or equivalent experience.
BS / BA degree; In lieu of degree, the following may be substituted: 6 years of additional comparable work experience beyond the required years of experience, OR an Associate degree with an additional 4 years of comparable work experience beyond the required years of experience
2 years of Healthcare / Health Plan experience
2 years of HEDIS experience and/or knowledge
Strong data management and/or project management skills
Solid knowledge of managed care requirements related to clinical quality
Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
Excellent time management and prioritization skills
Excellent written and verbal communications skills
Strong proficiency with Microsoft Office applications, including Word, Excel, and PowerPoint
Significant Clinical and/or Health Education experience
Experience working with HEDIS software vendors (management, building relationships, issue resolution, etc.)
Experienced in medical record review
Proficiency with Microsoft Windows Suite (PPT, Excel, Word, Visio)
Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma, Lean, and/or PDSA
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 350,000 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)
PLEASE NOTE The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.
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.
Job keywords: quality, HEDIS, consultant, NCQA, Dallas, TX, Texas
Unitedhealth Group Inc.