POSITION DESCRIPTION

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) 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 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.

CQC WILL COVER FROM MARCO ISLAND NORTH TO MANATEE AREA. MOST OF THIS MARKET WILL BE ON THE NORTH END OF THE TERRITORY. MAIN OFFICE: 13751 METROPOLIS AVE, FORT MYERS, FL

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
• Performs other duties as assigned

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.

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 380,000+ 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)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employers 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.

REQUIRED QUALIFICATIONS:

• Associate Degree (in lieu of degree, 2 years of additional comparable work experience beyond the required years of experience may be substituted in lieu of a associate degree)
• 1+ year experience Healthcare/Health Plan
• 1+ year HEDIS experience and/or knowledge
• Professional experience persuading changes in behavior
• Solid knowledge of managed care requirements related to clinical quality
• Strong 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

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.