RN, Clinical Quality HEDIS Nurse - Remote

WellMed, part of the Optum family of businesses, is seeking a RN, Clinical Quality HEDIS Nurse to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Clinical Quality RN will drive consistency, efficient processes and share best practices in a collaborative effort with the Quality team and leadership in order to facilitate a minimum 4 STAR rating. The Clinical Quality RN will participate in quality improvement initiatives including Chart Chase and Supplemental Data Source (SDS) and Primary Source Verification (PSV) as well as Quality Assurance and Overreading work. This position will work collaboratively with other staff members, managers and leadership and the market in a matrix relationship.

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

Primary Responsibilities:

• Complete SDS, PSV, Over-read throughout the year achieving and maintaining high productivity goals in order to improve Stars measures to be 4 STARS or higher
• Achieve and maintain a high level of accuracy rates of 98% or above
• Serve as a Subject matter expert on HEDIS Measures, DataRAP and Chart Chase Tool (CCT)
• Be the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
• Assist in developing of training and materials to help team achieve best practices in Stars and HEDIS
• Performance as requested by or required by Quality
• Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes
• Focus communications and efforts accordingly
• Develop solution-based, user friendly initiatives to support practice success

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

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:

• Bachelor of Science in Nursing, Healthcare Administration or a related field. (8+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
• Registered Nurse with current license in Texas, or other participating compact States
• 5+ years of progressively responsible healthcare experience to include experience in a managed care setting, and/or hospital settings, and/or physician practice setting
• 3+ years of experience in managed care with 2+ years of Utilization Management experience
• Knowledge and experience with CMS and/or NCQA
• Willing to occassionally travel in and/or out-of-town as demeed neccessary

Preferred Qualifications:

• Health Plan or MSO quality, audit or compliance experience
• Auditing, training or leadership experience
• Solid knowledge of Medicare and HEDIS standards

Physical and Mental Requirements:

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended perod of time
• Ability to use fine motor skills to operate offie equipment and/or machinery
• Ability to receive and complrehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

*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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.