Clinical Quality LVN - HEDIS/STARS

    • McAllen, TX

Position 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)

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

This position is responsible for the coordination of HEDIS and STARs data gathering process within the clinic setting. This role is responsible for the education to the clinic on quality measures and coordinates strategies for closing gaps. Evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, maintaining accurate records of review activities, developing formal training and improvement programs and maintaining up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines.

Location: McAllen, TX.

Primary Responsibilities:

  • Analyze data, evaluate for possible data integrity and data deficits and document findings
  • Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
  • Obtains quality detail report and flags patient's charts with the missing measures
  • Works closely with local leadership to execute quality strategies
  • Supports and assists PCPs/clinics with quality data collection
  • Provides reports and monitors performance at local level
  • Engages PCP and clinic staff in developing strategies to close quality gaps
  • Supports and improves communications between market and corporate departments
  • Maintains education/knowledge base of HEDIS/STARs standards and guidelines
  • 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:

  • Licensed Vocational/Professional Nurse
  • Prior HEDIS/STAR experience or participation with similar regulatory reporting
  • 3+ years of healthcare experience to include experience in a managed care setting
  • 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
  • Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets


Preferred Qualifications:
  • 2+ years of college, in pursuance of a Bachelor's or Associate's degree
  • 2+ years of experience working with HEDIS/STAR measures

Physical and Mental Requirements:
  • Ability to lift up to 25 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

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 350,000+ 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)

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: Licensed Vocational Nurse, LVN, LPN, HEDIS, STARS, Quality Improvement, Chart Audit, data analysis.


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