Clinical Quality RN Supervisor - Telecommute
San Antonio, TX 
Posted 10 days ago
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)

The Quality Improvement Manager is responsible for coordinating and implementing the HEDIS and STAR's data collection and works in collaboration with the Director of Quality to develop strategies for achieving a 5 STAR rating. This role assists with data integrity and report preparation for all required data submissions. Directly responsible to manage teams of clinical and nonclinical staff who perform central call initiatives such as performing telephonic outreach to retrieve and/or disseminate appropriate information as relates to member care and CMS quality measures as well as to resolve quality gaps. The Quality Improvement Manager provides direction and support to various corporate interdepartmental teams and WellMed markets in the implementation of strategies for closing care gaps. This role reports initiatives to quality field teams across multiple markets. This role works closely and collaboratively with various functional areas of the healthcare and IT delivery systems to achieve the goals and objectives of the Quality Improvement Program.

If you are located within the Central Time Zone, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Provides leadership and support in establishing and executing the Quality Performance Initiatives in alignment with corporate goals
  • Supervises and coordinates the work activities of the team
  • Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met
  • Collaborates with physicians and support staff to execute the implementation of the clinical quality initiatives as defined by the enterprise
  • Provides expertise to the corporate training department on STAR/HEDIS measures and on the tools that support the collection of STAR/HEDIS data
  • Work with IT on the interpretation of technical specifications and impact of HEDIS/STAR Measures related to data collection applications and reports utilized for the support of HEDIS/STAR measures
  • Participate in NCQA HEDIS or Health Plan audits
  • Work with internal market teams and external vendors on data transmission issue
  • Monitor and analyze large volume of electronic submissions for possible data deficit issues Utilize internal audit tracking tools for review and validation of data integrity
  • Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates based on HEDIS supplemental submission requirements via enterprise data systems and team work processes. Provide process improvement strategies to enterprise leadership for improving data capture and outcomes
  • Update QI Project templates, staff training materials, and Work Plans with assigned responsibilities
  • Attend and participate in all QI related meetings
  • Performs all other related duties as assigned

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:

  • Unrestricted Nursing License in Texas or Florida
  • Registered Nurse with Undergraduate degree or equivalent experience
  • 5+ years of experience within a healthcare environment including experience within a managed care setting, with 3+ years of management experience
  • 3+ years of experience with data analysis
  • HEDIS/STAR experience or participation with regulatory reporting
  • Basic understanding of quality improvement standards such as NCQA, HEDIS, CAHPS, HOS and CMS
  • Capability to work with people at all levels in an organization
  • Excellent training and presentation skills with solid communication capabilities and practices, both oral and written
  • Advanced Experience using Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays

Preferred Qualifications:

  • BSN degree or related field
  • CPHQ Certification
  • CHCQM Certification
  • 3+ years of process management experience
  • Healthcare Quality Improvement experience
  • Demonstrated effective organizational skills
  • Excellent communication, writing, proofreading and grammar skills
  • Solid attention to detail and accuracy, excellent Evaluative and Analytical skills
  • Solid teamwork, interpersonal, verbal, written, and administrative and customer service skills
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Physical & Mental Requirements:

  • Ability to lift up to 25 pounds
  • Ability to sit 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

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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 550,000+ 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)

*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: Population Health, RN, Registered Nurse, Leadership, Supervisor, Quality Improvement, HEDIS, Call Center, Data Analysis, Managed Care, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote


Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
5+ years
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