Senior Quality Nurse Job at Optum, Albuquerque, NM

TGdYMGx0TlVJQm5zbGZub0NKVElQVUVJd0E9PQ==
  • Optum
  • Albuquerque, NM

Job Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Sr. Clinical Quality Consultant (CQC) RN will drive consistency, efficient processes and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 STAR quality performance. The Sr CQC will be provider facing and participate in quality improvement initiatives, attend monthly or joint operating committee meetings, and develop recommendations for quality improvement. This position is responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship. Primary Responsibilities:

  • Develop business plans to motivate providers to improve STARS measure performance
  • Provide analytical interpretation and STARS/HEDIS performance summaries to provider groups
  • Be the subject matter expert for all STARS-related activities within their assigned territory working within a matrix relationship
  • Participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider performance
  • Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel to identify the most effective approaches and strategies to improve STARS measure performance
  • Assist in developing STARS/HEDIS presentation materials for provider performance meetings
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 NM and/or a compact state. In lieu of RN license, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
  • 4+ years of healthcare experience
  • 2+ years of experience in provider-facing interactions
  • Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
  • Ability to review clinical data and provide recommendations for improvement
  • Valid NM Driver's license and ability to travel 75% locally
Preferred Qualifications:
  • 2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
  • 2+ years of data analysis and/or quality chart review and abstraction
  • Billing and CPT coding experience
  • Medicare and/or Managed Care experience
Physical & Mental Requirements:
  • Ability to lift up to 10 pounds
  • Ability to push or pull heavy objects
  • 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
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 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 Tags

Similar Jobs

Capital One

Manager, Product Management - Nexus Risk Data Products Team Job at Capital One

Manager, Product Management - Nexus Risk Data Products Team Product Management at Capital One is a booming, vibrant craft that requires reimagining the status quo, finding value creation opportunities, and driving innovative and sustainable customer experiences... 

Zaxby's

Cashiers - Part Time (15-20 hours) Job at Zaxby's

This is the ideal role for anyone needing a part time job! Whether you're in school, working multipe jobs, stay at home mom.. we're here for you. We can work with your scheduling needs and there is no experience necessary for this role! Looks like fun. Feels like home... 

Get It - Marketing

Senior SEO Analyst - Remote | WFH Job at Get It - Marketing

Senior SEO Analyst Remote | Full-Time | Up to $75,000 DOE + Benefits About the Role Are you passionate about SEO and ready to...  ...clients. You'll work with cross-functional teamsincluding Sales, PPC, Social Media, and PRto create innovative campaigns that... 

California Job Shop

Preschool Director Job at California Job Shop

 ...Preschool Directorto lead an Early Education Departmentwithlove, care, and a vision for nurturing precious neshamos. The preschool...  ...with the overall vision and values of the school. Manageday-to-day operations, including carpool, scheduling, and program planning... 

Interim HealthCare Inc.

Pediatric Home Health Aide (HHA) / Certified Nursing Assistant (CNA) Job at Interim HealthCare Inc.

Pediatric Home Health Aide (HHA) - Certified Nursing Assistant (CNA) PRN & Part Time Home Health assignments throughout the Des Moines, IA area Experience a work culture where Caregivers / Home Health Aides are valued, management backs you and youre empowered to be...