Clinical Quality Consultant I Hybrid in Orlando 2364810 | Orlando, FL | WellMed

Clinical Quality Consultant I

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Clinical Quality Consultant I will drive consistency through data mining; efficient processes reporting, CAHPs/HOS action planning and shared trend analysis - in a collaborative effort within the quality department- designed to facilitate a minimum 4 STAR rating. CQCI will participate in quality improvement initiatives while data mining for quality remediation plans and create tools and databases to capture relevant data for each assigned group. This position will work collaboratively with the Education Consultant for each region for education/ outliers and barrier discussions. This role will also work collaboratively with the Corporate Quality team on enterprise initiatives and activities in a matrix relationship.

This position follows a hybrid schedule with three in-office days per week and 75% travel in Orlando and surrounding areas.

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.
• 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
• Identify 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:

• 1+ years of experience Healthcare/Health Plan
• 1+ years of HEDIS experience and/or knowledge
• Professional experience persuading changes in behavior
• Solid knowledge of managed care requirements related to clinical quality
• Solid knowledge of the Medicare market, products and competitors
• Experience in managed care working with network and provider relations
• Microsoft Office specialist with exceptional attention to detail

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
• Demonstrated ability to solve process problems crossing multiple functional areas and business units
• Proven solid communication and presentation skills
• Proven solid relationship building skills with clinical and non-clinical personnel
• Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven good business acumen, especially as it relates to Medicare

Physical & Mental Requirements:

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

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). The hourly pay for this role will range from $24 - $43 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

UnitedHealth Group 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.

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