HEDIS Clinical Quality Consultant II Fort Worth TX

    • Fort Worth, TX

Position Description

The Clinical Quality Consultant II (CQC) will drive consistency, efficient processes and share best practices, in a collaborative effort with the providers, designed to facilitate a minimum 4 STAR performance. The 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.

Based in Fort Forth, TX, but will travel 75% locally to provider offices

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
  • Lead or participate and present in 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 by or required by Quality or Regional leadership
  • 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 personnel with a focus on identifying barriers to achieving targeted outcomes
  • Develop 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:
  • BS / BA Degree (in lieu of degree, the following may be substituted: 6 years of additional comparable work experience beyond the required years of experience OR An Associate Degree with an additional 4 years of comparable work experience beyond the required years of experience)
  • 2+ years of Healthcare / Health Plan experience
  • 2+ years of HEDIS experience and/or knowledge
  • Strong data management and / or project management skills
  • Solid knowledge of managed care requirements related to clinical quality
  • Demonstrated ability to assist with focusing activities toward a strategic direction and achieve targets
  • Strong proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint
  • Ability to travel via car up to 75% of the time or more, depending on provider needs

Preferred Qualifications:
  • Significant Clinical and / or Health Education experience
  • Experience working with HEDIS software vendors (management, building relationships, issue resolution etc.)
  • Experienced in medical record review
  • Proficiency with Microsoft Windows Suite (PPT, Excel, Word, Visio)
  • Basic statistical knowledge and application of continuous quality improvement concepts, such as Six Sigma, Lean, and / or PDSA
  • Excellent team development skills
  • Excellent time management and prioritization skills
  • Excellent written and verbal communications skills

Physical & Mental Requirements:
  • Ability to lift up to 10 pounds
  • Ability to push or pull heavy objects using pounds of force 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 properly drive and operate a vehicle
  • Ability to receive and comprehend instructions verbally and / or in writing Ability to use logical reasoning for simple and complex problem solving

If the hired individual resides in Florida (office based or ) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.

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 240,000+ 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: CQC, Clinical Quality, Consultant, Medical Practice, HEDIS, STARS, Coach, education, Health plan, data management, Fort Worth,TX, Texas

With offices around the world, UnitedHealth Group's headquarters are located in the Minneapolis metropolitan area.

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