Clinical Programs RN Manager - Remote - Remote Eligible

Clinical Programs RN Manager

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Programs RN Manager 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 VP of Clinical Operations and Quality STARS team to develop strategies for achieving a 5 STAR rating. This role assists with data integrity and report preparation for all required data submissions.

The Clinical Programs RN Manager provides direction and support to various corporate interdepartmental teams and 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. You will have the flexibility to work remotely as you take on some tough challenges.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provides leadership and support in establishing and executing the Quality Performance Initiatives in alignment with corporate goals
• Manages and is accountable for professional staff, may oversee work activities of other supervisors, and coordinates the work activities of the team
• Adapts departmental plans and priorities to address business and operational needs/challenges in collaboration with senior leadership
• Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met
• Influences or provides input to forecasting and planning activities
• Collaborates with physicians and support staff to execute the implementation of the clinical quality initiatives as defined by the enterprise
• Monitor progress toward plan goals through evaluation of the effectiveness of clinical programs and/or services provided
• Provides expertise to the corporate training department on STAR/HEDIS measures and on the tools that support the collection of STAR/HEDIS data
• 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
• Participate in NCQA HEDIS or Health Plan audits
• Work with internal market teams and external vendors on data transmission issues
• 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
• 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. Provide process improvement strategies to enterprise leadership for improving data capture and outcomes
• Update QI Project templates, staff training materials, and Work Plans with assigned responsibilities
• Attend and participate in all QI related meetings
• Performs all other related duties as assigned

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

Preferred Qualifications:

• BSN degree or related field
• CPHQ Certification
• CHCQM Certification
• 3+ years of process management experience
• 1+ years of experience with direct people management experience
• Healthcare Quality Improvement experience
• Excellent communication, writing, proofreading and grammar skills
• Effective organizational skills
• Solid attention to detail and accuracy, excellent Evaluative and Analytical skills
• Solid teamwork, interpersonal, verbal, written, and administrative and customer service skills
• Bilingual preferred with preference given to Spanish and Vietnamese

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.