Clinical Quality LVN - Dallas, TX - Full-time / Part-time

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. 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)
 
This position is responsible for the coordination of HEDIS and STARs data gathering process within the clinic setting. This role is responsible for the education to the clinic on quality measures and coordinates strategies for closing gaps.  Evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, developing formal training and improvement programs and maintaining up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines.    
 
Primary Responsibilities:

Analyze data, evaluate for possible data integrity and data deficits and document findings
Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
Obtains quality detail report and flags patient’s charts with the missing measures
Works closely with local leadership to execute quality strategies
Supports and assists PCPs/clinics with quality data collection
Provides reports and monitors performance at local level
Engages PCP and clinic staff in developing strategies to close quality gaps
Supports and improves communications between market and corporate departments
Maintains education/knowledge base of HEDIS/STARs standards and guidelines
Performs all other related duties as assigned

Required Qualifications:

Licensed Vocational/Professional Nurse
Prior HEDIS/STAR experience or participation with similar regulatory reporting
Three or more years of healthcare experience to include experience in a managed care setting
Three or more years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
Preferred Qualifications:

Two or more years of college, in pursuance of a Bachelor’s or Associate’s degree
Two or more years of experience working with HEDIS/STAR measures
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 90,000+ 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: 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, Star, Measures, Data Analysis, Chart Reviews, Database, Excel Spreadsheets, Analyze, Audit, Data Gathering, Closing gaps, quality review, medical record review, regulatory, standards, patient charts, NCQA, quality measures, IS review, integrity, CHCA, Dallas, Forth Worth, TX, Texas