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LVN Clinical Quality Consultant

Company: UnitedHealth Group
Location: Harlingen
Posted on: August 1, 2019

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) This position is responsible for HEDIS and STAR education in contract provider clinics. Consultant provides education to providers and staff on all quality measures and suggests strategies for performance improvement. Evaluates the quality and completeness of clinical documentation by performing quality medical record reviews. Assists in improvement of the clinical documentation process. Maintains accurate records of review and educational activities. Maintains current knowledge of all regulatory standards and guidelines. Works collaboratively with all departments providing service to contract physicians. Takes initiative to provide assistance whenever a need is identified. Primary Responsibilities:

  • Analyze and trend HEDIS/STAR rates, identify barriers to improvement. Works closely with local leadership to execute quality strategies
  • Assists clinics with quality data collection as needed
  • Prepares, delivers, identifies areas of greatest need for change, and explains quality reports at least monthly
  • Engages PCP and clinic staff in developing strategies to close quality gaps
  • Supports and improves communications between market and corporate departments
  • Maintains education/knowledge base of HEDIS/STAR standards and guidelines
  • Educates providers and office staff on all quality metrics, documentation required to meet metrics and correct way to submit all quality data
  • Monitors failed validation reports and uses them as teaching tools to improve clinic functions
    Required Qualifications:
    • Licensed Vocational Nurse in the state of Texas
    • 3+ years of healthcare experience to include experience in a managed care setting
    • Ability to review data and provide recommendations for improvement
    • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
    • This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diptheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease Preferred Qualifications:
      • 2+ years of college, in pursuit of a Bachelor or Associate degree
      • Prior HEDIS/STAR experience or participation with similar regulatory reporting
      • Experience with data analysis/quality chart reviews 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 350,000+ 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)

        OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians. WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: LVN Clinical Quality Consultant, Harlingen, Texas, TX

Keywords: UnitedHealth Group, Harlingen , LVN Clinical Quality Consultant, Professions , Harlingen, Texas

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