United Spinal Association Jobs

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 Clinical Quality Consultant 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 CQC 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 each regional/market team and their leadership 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

• Assist in developing of training and analytical materials for Stars and HEDIS

• Lead or participate and present 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

• Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies

• Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes 8. Focus communications and efforts accordingly

• Develop solution-based, user friendly initiatives to support practice success

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:

• Registered Nurse (within the states in which service is being delivered) with undergraduate degree or (4+ years equivalent experience above and beyond the required years of experience may be considered in lieu of undergraduate degree)

• 4+ years of associated business experience within thehealth care industry including experience with HEDIS/Stars

• Experience influencing others resulting in changes in behavior (preferably with providers in various care delivery models)

• Experience in managed care working with network and provider relations

• Experience in provider-facing HEDIS strategy and education

• Experience presenting education of HEDIS/Stars material to providers and provider office staff

• Solid knowledge of the Medicare market, products and competitors

• Knowledge base of clinical standards of care, preventative health, and Star measures

• Financial analytical background within Medicare Advantage or government programs (Risk Adjustment/STARS Calculation models)

• Medical/clinical background

• Microsoft Office specialist with exceptional attention to detail; must be proficient with Excel

• Ability to travel 50 - 75% locally with occasional overnight travel

Preferred Qualifications:

• Undergraduate degree preferred, post graduate degree highly preferred

• Billing and CPT coding experience

• Clinical data abstraction experience

• Proven solid communication and presentation skills

• Proven solid relationship building skills with clinical and non-clinical personnel

• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels

• Demonstrated ability to solve process problems crossing multiple functional areas and business units

• Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

• Proven adaptable to change

• Proven excellent customer service skills

• Proven good business acumen, especially as it relates to Medicare

Physical & Mental Requirement:

• Ability to push or pull heavy objects using up to pounds of force

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.