Clinical Quality Consultant I Wellmed Network Of Florida

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. 

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 for HEDIS and CAHPs and HOS.  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  assigned site.  All of this remarkable improvement-focused work completed on-site and in partnership with the office staff at each of the assigned sites.

This position will work collaboratively with the Quality Manager and local cross-functional teammates.       

Primary Responsibilities: 

• Develop market business plans to motivate providers to engage in improving STARS and CAHPs and HOS measures to be 4 STARs or higher for all payors and work with site designee onsite to execute those plans.
• Provide analytical interpretation of STARs/HEDIS and CAHPs and HOS 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

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. 

Years of post-high school education can be substituted/is equivalent to years of experience

Required Qualifications: 

• Active LPN or RN licensure (in lieu of licensure, 2 years of additional comparable work experience beyond the required years of experience)
• 1 years of experience Healthcare/Health Plan
• 1 years HEDIS experience and/or knowledge
• Professional experience persuading changes in behavior
• Experience in managed care working with network and provider relations
• Solid knowledge of managed care requirements related to Clinical Quality
• Solid knowledge of the Medicare market, products and competitors
• Proven Microsoft Office specialist with exceptional attention to detail

Preferred Qualifications: 

• Active RN Licensure
• Clinical and/or Health Education experience
• Knowledge base of clinical standards of care, preventative health, and Star measures
• Solid communication and presentation skills
• Solid relationship building skills with clinical and non-clinical personnel
• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
• Proven ability to solve process problems crossing multiple functional areas and business units
• Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven good business acumen, especially as it relates to Medicare

Physical & Mental Requirement: 

• Ability to push or pull heavy objects using pounds of force

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: 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.