Job Description

Job Description

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

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The WellMed Clinical Programs RN Supervisor is directly responsible to manage teams of clinical and nonclinical staff who perform central call initiatives such as performing telephonic outreach to retrieve and/or disseminate appropriate information as relates to member care and CMS quality measures as well as to resolve quality gaps. Directly responsible for coordinating and implementing the HEDIS and STAR’s data collection and works in collaboration with the Director of Quality to develop strategies for achieving a 5 STAR rating. This role assists with data integrity and report preparation for all required data submissions.

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The Clinical Programs RN Supervisor provides direction and support to various corporate interdepartmental teams and WellMed markets in the implementation of strategies for closing care gaps. This role reports initiatives to quality field teams across multiple markets. This role works closely and collaboratively with various functional areas of the healthcare and IT delivery systems to achieve the goals and objectives of the Quality Improvement Program. 

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If you have a compact license and willing to work required/rotating weekends and holidays, you will have the flexibility to work remotely* as you take on some tough challenges. 

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Primary Responsibilities:

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• Provides leadership and support in establishing and executing the Quality Performance Initiatives in alignment with corporate goals
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• Supervises and coordinates the work activities of the team
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• Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met
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• Collaborates with physicians and support staff to execute the implementation of the clinical quality initiatives as defined by the enterprise
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• Provides expertise to the corporate training department on STAR/HEDIS measures and on the tools that support the collection of STAR/HEDIS data
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• Work with IT on the interpretation of technical specifications and impact of HEDIS/STAR Measures related to data collection applications and reports utilized for the support of HEDIS/STAR measures
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• Participate in NCQA HEDIS or Health Plan audits
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• Work with internal market teams and external vendors on data transmission issues
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• Monitor and analyze large volume of electronic submissions for possible data deficit issues. Utilize internal audit tracking tools for review and validation of data integrity
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• Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates based on HEDIS supplemental submission requirements via enterprise data systems and teamwork processes.
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• Provide process improvement strategies to enterprise leadership for improving data capture and outcomes
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• Update QI Project templates, staff training materials, and Work Plans with assigned responsibilities
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• Attend and participate in all QI related meetings
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• Performs all other related duties as assigned
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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:

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• Active, unrestricted Registered Nurse eLNC Compact licensure in state of residency 
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• 5+ years of RN experience, including experience in a managed care setting
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• 5+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
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• 2+ years of Call Center Experience
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• 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review paper and electronic medical records and charts
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• Experienced using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets. Must be proficient in Excel
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• Solid knowledge of the Medicare HEDIS/Stars measures
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• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
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• Demonstrated ability to manage multiple complex, concurrent projects
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• Demonstrated excellent written and verbal communication and relationship building skills
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• Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
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• Demonstrated excellent customer service skills and communication skills
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Preferred Qualifications:

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• BSN degree or related field 
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• CPHQ Certification 
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• CHCQM Certification 
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• 3+ years of process management experience
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• Healthcare Quality Improvement experience.
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• Demonstrated excellent communication, writing, proofreading and grammar skills
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• Demonstrated effective organizational skills
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• Demonstrated solid attention to detail and accuracy, excellent Evaluative and Analytical skills
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• Demonstrated solid teamwork, interpersonal, verbal, written, and administrative and customer service skills
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*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

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Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. 

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Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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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.

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UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Tags

Minimum wage, Full time, Work experience placement, Work at office, Local area, Remote work,

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