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Clinical Quality Consultant - Telecommute within St Louis, MO area

02/05/2019Call Center
Job Location:
St. Louis, MO
Metro Area:
MO - Saint Louis
Company Name: UnitedHealth Group
Website:  Click to Visit
UnitedHealth Group
At OptumHealth, you will perform within an innovative culture that is focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that is greater than you have ever imagined. In this career, you’ll drive consistency, efficient processes and share best practices - in a collaborative effort with the providers - designed to facilitate a minimum 4 STAR rating. You’ll actively participate in quality improvement initiatives, develop recommendations for quality remediation plans, and create tools and databases to capture relevant data. If you are located in St Louis, MO, you will have the flexibility to telecommute* as you take on some tough challenges.  This is a work at home opportunity with approximately 50% local travel to provider sites. Territory will consist of the greater St Louis, MO area with potential for state wide travel. Territory also has potential of travel to Kansas area. 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 United Healthcare's Regional Vice President, Administrative Call Center Team, Health Plan Medical Directors, and other Health Plan and Optum team members to assure that all STARS activities are planned and executed Assist OPTUM and UnitedHealthcare in development of training and analytical materials for Stars and HEDIS Lead 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 or required by the Health Plan and the Director of Market Consultation 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 personal with a focus on identifying barriers to achieving targeted outcomes. Focus communication and efforts accordingly Develop solution-based, user friendly initiatives to support practice success

Qualifications:

Required Qualifications: 5+ years associated business experience with health care industry Knowledge base of clinical standards of care and preventive health Experience in managed care working with network and provider relations/contracting 3+ years of financial analytical background within Medicare Advantage plans Microsoft Office specialist with exceptional analytical and data representation expertise; Excel, Outlook, and PowerPoint skills Preferred Qualifications: Undergraduate degree RN license current and unrestricted STARS experience highly Strong communication and presentation skills Strong relationship building skills with clinical and non-clinical personnel 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 Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions, and devise and implement an appropriate plan of action Good business acumen, especially as it relates to Medicare Medical/clinical background highly desirable Post graduate degree highly preferred CRC (Certified Risk Adjustment Coder) & CPC (Certified Procedural Coder) Professional experience persuading changes in behavior Strong knowledge of the Medicare market, products and competitors Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM   *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy   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: CRC & CPCs certifications, Clinical Quality Consultant, Medicare Advantage, RN license, STARS, HEDIS, reporting, St. Louis, MO, Missouri
 
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