RN Senior Quality & Compliance Lead — HEDIS Focus
UnitedHealth Group
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Benefits offered by this job
Job summary
UnitedHealth Group, through WellMed in Houston, is seeking an experienced RN to support quality and HEDIS initiatives within contracted provider networks. You will educate clinics on performance expectations, perform oversight activities, and drive corrective actions.
The role requires navigating multiple EMR platforms and strong knowledge of CMS/NCQA/HEDIS standards. The ideal candidate holds an active RN license with 5+ years of clinical nursing and 2+ years in managed care, plus strong
Qualifications
- Active, unrestricted RN license.
- 5+ years of clinical nursing experience.
- 2+ years of managed care experience.
- Experience with audits, delegation oversight, utilization management, quality improvement, or clinical compliance activities.
- Experience with quality reporting and audit documentation tools.
- Solid understanding of CMS, NCQA, HEDIS, and regulatory/accreditation requirements.
- Proficiency in Microsoft Outlook, Teams, Word, Excel, and PowerPoint.
- Proficiency in Microsoft Copilot and general AI-enabled tools.
- Proficiency in educating, influencing, and presenting to providers and clinic leadership.
- Proven ability to navigate multiple EMR platforms used by provider groups.
- Must reside in the Houston, TX market.
- Willing and able to travel throughout the assigned market as needed.
- Valid driver's license required, along with reliable transportation for local travel.
Responsibilities
- Support contracted providers within the Houston market on quality and HEDIS initiatives.
- Conduct provider and clinic education regarding quality measures and performance expectations.
- Perform delegated oversight activities, audits, monitoring, and compliance reviews.
- Analyze audit findings, identify trends and risks, and recommend corrective actions.
- Lead provider-facing meetings and communicate performance results.
- Support gap closure activities and quality improvement initiatives.
Education
Tools
Job description
UnitedHealth Group, through WellMed in Houston, is seeking an experienced RN to support quality and HEDIS initiatives within contracted provider networks. You will educate clinics on performance expectations, perform oversight activities, and drive corrective actions.
The role requires navigating multiple EMR platforms and strong knowledge of CMS/NCQA/HEDIS standards. The ideal candidate holds an active RN license with 5+ years of clinical nursing and 2+ years in managed care, plus strong
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