Senior Clinical Quality RN - Hybrid East Valley

Optum; Phoenix (AZ); Hybrid; USD 71,000 - 141,000; Full time

Job summary

An established industry player seeks a Senior Clinical Quality Consultant RN to drive quality performance in healthcare. This hybrid role offers the opportunity to innovate and collaborate with provider groups, focusing on quality improvement initiatives and data analysis. With a commitment to diversity and inclusion, the company provides a supportive environment for professional growth. If you're passionate about enhancing healthcare quality and enjoy working in a dynamic setting, this is the perfect opportunity for you.

Benefits

Comprehensive benefits package

Incentive programs

Stock purchase options

401(k) plan

Qualifications

• 4+ years of healthcare experience including provider interaction.
• Registered Nurse license in AZ or compact state required.

Responsibilities

• Develop business plans to improve STAR measure performance.
• Analyze provider structure to identify improvement strategies.

Skills

Healthcare experience

Provider-facing interaction

Microsoft Office proficiency

Analytical skills

Education

Registered Nurse license

Post-high school education

Job description

Position: Senior Clinical Quality Consultant RN (Hybrid - Phoenix, AZ)

Location: Hybrid role based in Phoenix, AZ, requiring time in the field, working from home, and occasional office meetings or training.

Join us to innovate in healthcare, moving beyond basic care to integrated health programs across the continuum of care. We aim to Caring. Connecting. Growing together.

The Senior Clinical Quality Consultant RN will promote consistency, efficient processes, and share best practices in collaboration with provider groups to achieve a minimum 4 STAR quality performance. Responsibilities include participating in quality improvement initiatives, developing remediation plans, and creating tools for data capture across regions. This role involves working closely with regional teams and may lead a team of clinical quality consultants, overseeing network quality performance.

Primary Responsibilities:

1. Develop business plans to motivate providers to improve STAR measure performance.
2. Provide analytical summaries of STAR/HEDIS performance to provider groups.
3. Serve as the subject matter expert for all STAR-related activities within the assigned territory, working within a matrix relationship.
4. Participate in and present at various review meetings related to STAR activities.
5. Analyze provider structure and characteristics to identify effective strategies for performance improvement.
6. Assist in developing presentation materials for provider performance meetings.

This role offers recognition and development opportunities in a challenging environment with clear success criteria. A minimum of one year of post-high school education can substitute for one year of experience.

Required Qualifications:

• Registered Nurse license in AZ or a compact state.
• 4+ years of healthcare experience.
• 2+ years of provider-facing interaction experience.
• Proficiency with Microsoft Office applications.
• Ability to travel locally 50%.
• Valid driver’s license and reliable transportation.

Preferred Qualifications:

• 2+ years in HEDIS/STARS, preferably as a clinical quality consultant.
• Experience in clinical data abstraction and quality chart reviews.
• Billing and CPT coding experience.
• Medicare or managed care experience.

The salary range is $71,600 to $140,600 annually, depending on experience, education, and other factors. Benefits include comprehensive packages, incentive programs, stock purchase options, and 401(k). We are committed to diversity, equity, and inclusion, ensuring equitable care and opportunities for all.

OptumCare is an Equal Employment Opportunity employer and a drug-free workplace, requiring a drug test prior to employment.