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 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 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

This is an office-based position, Oaks II/Network BLVD., 78249 / Office park located at IH 10 East and De Zavala Road / Local and Non-Local travel is required as determined by the business 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. REQUIRED QUALIFICATIONS:

• Registered Nurse (within the states in which service is being delivered) with undergraduate degree or (4 years equivalent experience above and beyond the required years of experience may be considered in lieu of undergraduate degree)
• 4 or more years of associated business experience within the health care industry including experience with HEDIS/Stars
• 50 - 75% local travel required, with occasional overnight travel
• Previous experience influencing others resulting in changes in behavior (preferably with providers in various care delivery models)
• 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
• Financial analytical background within Medicare Advantage or government programs (Risk Adjustment/STARS Calculation models)
• Previous experience in provider-facing HEDIS strategy and education
• Experience presenting education of HEDIS/Stars material to providers and provider office staff
• Microsoft Office specialist with exceptional attention to detail; must be proficient
• with Excel

PREFERRED QUALIFICATIONS:

• Billing and CPT coding experience
• Clinical data abstraction experience
• 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
• Adaptable to change
• Excellent customer service skills
• Good business acumen, especially as it relates to Medicare
• Medical/clinical background highly desirable
• Undergraduate degree preferred, post graduate degree

PHYSICAL & 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 properly drive and operate a vehicle
• 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 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) Diversity creates a healthier atmosphere: OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Job keywords: WellMed, Healthcare, Bilingual, RN, Registered Nurse, Managed Care, Health Plan or MSO quality, audit, Medicare, TDI HEDIS/STARS, auditing, training, CMS, URAC, NCQA, San Antonio, New Braunfels, Seguin, Gonzales, Yoakum, Boerne, Floresville, Texas, TX Job Details

• CONTEST NUMBER 845430
• JOB TITLE Registered Nurse RN Clinical Quality Consultant Healthcare San Antonio TX
• JOB FAMILY Nursing
• BUSINESS SEGMENT OptumCare

Job Location Information

• San Antonio, TX United States North America
• OTHER LOCATIONS New Braunfels, TX Gonzales, TX Helotes, TX Shiner, TX

Additional Job Detail Information

• EMPLOYEE STATUS Regular
• SCHEDULE Full-time
• JOB LEVEL Individual Contributor
• SHIFT Day Job
• TRAVEL Yes, 50 % of the Time
• TELECOMMUTER POSITION No
• OVERTIME STATUS Exempt

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.