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About UHG

Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Medical and Clinical Operations

Country:

US

Postal Code:

76101

Approximate Salary:

Not Specified

Position Type:

Full Time

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HEDIS Clinical Quality Consultant I

UHG - Fort Worth, Texas

Posted: 10/16/2018

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

 

The Clinical Quality Consultant I 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 CQCI 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 the Senior Quality Consultants for each regional/market. This role will also work collaboratively with the Corporate Quality team on enterprise initiatives and activities 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
  • Participate 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. 
  • Review provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
  • Focus communications and efforts accordingly
  • Develop solution-based, user friendly initiatives to support practice success

Required Qualifications:

  • Associate Degree (in lieu of degree, 2+ years of additional comparable work experience beyond the required years of experience may be substituted)
  • 1+ years experience Healthcare/Health Plan
  • 1+ years HEDIS experience and/or knowledge
  • Knowledge of managed care requirements related to clinical quality
  • Knowledge of the Medicare market, products and competitors
  • Experience in managed care working with network and provider relations
  • Microsoft Office specialist with exceptional attention to detail

Preferred Qualifications:

  • Clinical and/or Health Education experience
  • Knowledge base of clinical standards of care, preventative health, and Star measures
  • 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
  • Professional experience persuading changes in behavior

Physical and Mental Requirements:

  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

 

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 240,000+ 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, Fort Worth, STARS, Medicare, CMS, managed care, healthcare

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