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 startCaring. Connecting. Growing together.
The Clinical Quality Nurse Manager is responsible for providing supervision, direction and guidance on clinical quality improvement and management of programs as leader for the team of Clinical Quality Nurses across the Midwest Region. This position is responsible for developing strategy and implementation plans which drive clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as Network Account Managers, Healthcare Economics, and Analytics, Medical Directors, Reporting and Health Plan market leaders) with a goal of improving the health and well-being of our members and improving overall quality performance. The Manager is responsible for reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement using HEDIS and other tools driving to an overall Quality STAR performance of 4 STARs or higher. The Manager will conduct clinical quality audits and may also be responsible for upholding NCQA requirements. This position will report to the Regional Quality Director.
Hours are Monday through Friday 8AM- 5PM EST or CST time zone.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Manage and is accountable for the team of Clinical Quality Nurses across the Midwest Region
- Develop team direction and outreach/educational strategies around Quality STARs performance
- Adapt departmental plans and priorities to address business and operational challenges
- Collect Quality data and/or information based on applicable standards, state/federal or other regulations, customer or consumer requests, internal requests, or project assignments
- Identify appropriate sources for data or information either internally or externally and collect data/information
- Develop effective methods for data/information collection
- Identify appropriate data platform or application (e.g., data bases, Internet source, Intranet source) and utilize to collect data or information
- Investigate quality problems identified and collect additional information to close gaps
- Work cross functionally and coordinate with others internally or externally to gather information, overcome challenges to obtaining needed information
- Mine data and/or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant and/or are accurate and complete
- Provide explanations or updates when data/information (e.g., clinical/administrative) are note accurate or unclear
- Explain the characteristics of the data/information (e.g., clinical/administrative) including unique attributes
- Identify Quality improvement or intervention opportunities and work cross-functionally to develop interventions and recommendations
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
- 4+ years of healthcare experience, including experience in a managed care setting
- 2+ years of managerial experience
- 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
- 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
- Medicare experience
- Clinical data abstraction experience
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
- Ability to travel 25%, with occasional overnight travel
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.
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.
