Sr. Clinical Quality RN - Remote Eligible

Caring. Connecting. Growing Together.

The Sr. Clinical Quality RN (Sr. CQRN) 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. CQRN will participate in quality improvement initiatives, attend monthly or joint operating committee meetings, 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. This position has responsibility for the assigned network’s quality performance.

If you are located in KS or MO, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Develop market business plans to motivate providers and large or complex group leadership 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 subject matter expert for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
• Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider and large group performance and market performance as requested by or required by Quality or Regional leadership
• Analyze and evaluate provider and large group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
• Assist in developing of training and analytical materials for Stars and HEDIS

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:

• Active, Unrestricted RN License in the state of residence
• 4+ years of healthcare experience, including experience in a managed care setting
• 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Proficient in Excel
• Solid understanding of HEDIS measures
• Skilled in identifying and addressing care gaps to improve patient outcomes
• Ability to travel 25% with occasional overnight travel in the KS and MO area
• Driver’s license and access to reliable transportation
• Resident of KS or MO

Preferred Qualifications:

• 2+ years of experience in provider facing interactions, including provider education
• 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review data and provide recommendations for improvement
• Billing and CPT coding experience
• Clinical data abstraction experience
• Medicare experience

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). 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.

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. OptumCare is an Equal Employment Opportunity employer 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.

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