Job Description

The Clinical Quality Consultant I will drive consistency, efficient processes and share best practices - in a collaborative effort with the providers - designed to facilitate a minimum 4 STAR rating. The CQCI will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with the Senior Quality Consultants for each regional/market. This role will also work collaboratively with the Corporate Quality team on enterprise initiatives and activities in a matrix relationship.

Primary Responsibilities:

* Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
* Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
* 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.
* Participate in Weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership.
* Review provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
* Focus communications and efforts accordingly
* Develop solution-based, user friendly initiatives to support practice success
* Performs other duties as assigned.

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:

* Associate Degree (in lieu of degree, 2 years of additional comparable work experience beyond the required years of experience may be substituted in lieu of a associate degree)
* Minimum of 1 year experience Healthcare/Health Plan
* Minimum of 1 year HEDIS experience and/or knowledge
* Solid knowledge of managed care requirements related to clinical quality
* Strong knowledge of the Medicare market, products and competitors
* Experience in managed care working with network and provider relations
* Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
* You will be asked to perform this role in an office setting or other company location.

Preferred Qualifications:

* Clinical and/or Health Education experience
* Knowledge base of clinical standards of care, preventative health, and Star measures
* Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
* Good business acumen, especially as it relates to Medicare

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

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

Job Keywords: Clinical Quality, HEDIS, STARs, CMS, High-risk, Provider education, Health plan, Medicare, managed care, field, Tampa, Brandon, Clearwater, FL, Florida