Senior Clinical Quality RN - Hybrid East Valley

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

Job summary

An established industry player is seeking a Sr. Clinical Quality Consultant RN to drive quality performance in healthcare. This hybrid role in Phoenix offers the chance to collaborate with provider groups and lead quality improvement initiatives. You'll develop business plans, analyze performance metrics, and present findings to enhance care quality. Join a mission-driven organization committed to equitable healthcare, where your contributions will be recognized and rewarded. If you're passionate about making a difference and have the required experience, this opportunity is perfect for you.

Benefits

Comprehensive Benefits Package

Incentive and Recognition Programs

Equity Stock Purchase

401k Contributions

Qualifications

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

Responsibilities

• Develop business plans to motivate providers for STARS performance.
• Analyze provider structure to improve STARS measure performance.

Skills

Healthcare Experience

Provider-Facing Interactions

Analytical Skills

Microsoft Office Proficiency

Travel Ability

Education

Registered Nurse License

Post-High School Education

Tools

Microsoft Office

Job description

Position is Hybrid and based in Phoenix

(Time spent in the field, working from home, and occasionally in the office for meetings or training)

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 start Caring. Connecting. Growing together.

The Sr. Clinical Quality Consultant RN will drive consistency, efficient processes, and share best practices in collaboration with provider and large or complex groups, aiming to facilitate a minimum 4 STAR quality performance.

The Sr CQC 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 works collaboratively with each regional/market team and their leadership in a matrix relationship. It may serve as the team lead for the clinical quality consultants in the assigned market and is responsible for the network’s quality performance.

If located in the Phoenix, AZ metro area, you will have the flexibility to work from home and in the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities:

1. Develop business plans to motivate providers to improve STARS measure performance
2. Provide analytical interpretation and STARS/HEDIS performance summaries to provider groups
3. Be the subject matter expert for all STARS-related activities within the assigned territory working within a matrix relationship
4. Participate and present in weekly, monthly, quarterly, and annual business review meetings related to STAR activities which summarize provider performance
5. Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel to identify effective strategies to improve STARS measure performance
6. Assist in developing STARS/HEDIS presentation materials for provider performance meetings

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear guidance on success and development opportunities.

One year of post-high school education can be substituted or is equivalent to one year of experience.

Required Qualifications:

• Registered Nurse (within AZ and/or a compact state)
• 4+ years of healthcare experience
• 2+ years of experience in provider-facing interactions
• Proficiency with Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel
• Ability to travel locally 50%
• Driver’s license and access to reliable transportation

Preferred Qualifications:

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

The salary range for this role is $71,600 to $140,600 annually, based on full-time employment. Pay is determined by factors including local labor markets, education, experience, certifications, etc. UnitedHealth Group complies with all applicable minimum wage laws. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401k contributions. Benefits are subject to eligibility requirements.

At UnitedHealth Group, our mission is to help people live healthier lives and improve the health system for everyone. We are committed to addressing health disparities and enabling equitable care across all demographics.

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