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RN Clinical Quality Consultant for WellMed - Fort Myers, FL - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Fort Myers, FL Fort Myers, Florida |
About this job
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.
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)
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 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
- 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
Requirements
Required Qualifications:
- Registered Nurse with Undergraduate degree or equivalent experience
- 3 years 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:
- 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; post-graduate degree highly preferred
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.
WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.
Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.
Diversity creates a healthier atmosphere: 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.
Keywords: RN, Quality, HEDIS, 5 Start, Fort Worth, Medicare, CMS, Fort Myers, FL, Florida