Senior RN, Clinical Quality HEDIS Consultant - Fort Worth, TX
Company: Optum
Location: Venus
Posted on: May 21, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking a RN
to join our team in Fort Worth, 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 Sr. Clinical Quality Consultant (CQC) will drive consistency,
efficient processes and share best practices, in a collaborative
effort with the provider and large or complex groups, designed to
facilitate a minimum 4 STAR quality performance.
The Sr CQC will participate in quality improvement initiatives,
attend monthly or joint operating committee meetings, 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. -This position may serve as
the team lead for the clinical quality consultants in the assigned
market and has responsibility for the network's quality
performance. -
Primary Responsibilities:
Develop market business plans to motivate providers and large or
complex group leadership 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 subject matter expert for all STARS related
activities within their assigned market(s) working within a matrix
relationship which includes Quality corporate operations and
Regional/Market operations
Lead or participate and present in weekly, Monthly, Bi-monthly,
Quarterly and/or Annual business Review meetings related to STAR
activities which summarize provider and large group performance and
market performance as requested by or required by Quality or
Regional leadership.
Analyze and evaluate provider and large group structure and
characteristics, provider group/provider office operations and
personnel to identify the most effective approaches and
strategies
Assist in developing of training and analytical materials for Stars
and HEDIS
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
Performs all other related duties as assigned
This position has the ability to transition into a work at home
position once trained and strong performance is proven. There will
be meetings in the office that you will have to attend along with
travel in the market to provider offices.
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:
Current unrestricted Texas RN license or compact license
4+ years of healthcare experience, including experience in a
managed care setting
2+ years of experience in HEDIS/Star programs, preferably in a
clinical quality consultant role
2+ years of experience in provider facing interactions, including
provider education
2+ years of experience with data analysis and/or quality chart
reviews
Experience in managed care working with network and provider
relations
Experienced using Microsoft office applications, including
databases, word-processing, and excel spreadsheets. Must be
proficient in Excel
Ability to review data and provide recommendations for
improvement
Solid knowledge of the Medicare market, products and
competitors
Proven ability to influence providers to change behavior and drive
improvement in quality performance
Solid communication and presentation skills
Demonstrated ability to interact with medical staff, peers, and
internal company staff at all levels
Ability to solve process problems crossing multiple functional
areas and business units
Solid problem-solving skills; the ability to analyze problems, draw
relevant conclusions and devise and implement an appropriate plan
of action
Excellent customer service skills
25% local travel with occasional overnight travel
Driver's license and access to reliable transportation
Preferred Qualifications:
Undergraduate degree or postgraduate degree
Billing and CPT coding experience
Clinical data abstraction experience
Adaptable to change
Good business acumen, especially as it relates to Medicare
The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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.
Keywords: Optum, Euless , Senior RN, Clinical Quality HEDIS Consultant - Fort Worth, TX, Professions , Venus, Texas
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